Online Application Join Our Team Thank you for your interest in career opportunities at Bishop Spencer Place. Please fill out the form below. *Indicates required field Step 1 of 4 25% Contact InformationName* First Middle Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Preferred Contact Method* Home Phone Cell Phone Email Home Phone*Cell Phone*Referred By First Last SSN*Signature* Job PositionI am inquiring for*Can you provide proof that you are legal to work in the U.S.?* Yes No Are you 18 or over?* Yes No If under 18, verification of age and work certificate may be required upon hire.Available to work:* Full Time Part Time PRN (on call) Hours/Days available to work*Weekends* Yes No Have you reviewed the job description for the position for which you are applying?* Yes No If yes, are you able, with or without reasonable accommodation, to meet the requirements and perform the essential functions of the position?* Yes No Have you ever applied at Bishop Spencer Place?* Yes No If yes, when?Have you ever worked at Bishop Spencer Place?* Yes No Dates of employment at Bishop Spencer Place:Reason for leaving Bishop Spencer Place:Do you have any relatives who work at Bishop Spencer Place?* Yes No If yes, please state a name:Are you employed now?* Yes No If yes, may we contact your present employer?* Yes No Have you ever been convicted of any crime, other than a parking ticket, including traffic violations? This includes any conviction or any plea of guilty to a misdemeanor or felony charge and shall include any suspended imposition of sentence, any suspended execution of sentence or any period of probation or parole.* Yes No If yes, please provide the date, place, type of conviction, and the sentence received. (Conviction will not necessarily disqualify an applicant from employment). Factors such as date, nature, and seriousness of the offense will be taken into consideration.Do you have any pending charges for a class A, B, or D felony?* Yes No If yes, please describe the pending charges. ( What is the charge? Where is it pending?) Employment/Volunteer HistoryBegin with the most recent employer and list all employment for the last seven years. Information must be filled out completely. #1 EmployerAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneDates of Employment:Beginning/Ending Salary:Titles/Duties:Manager's name:Why did you leave?#2 EmployerAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneDates of Employment:Beginning/Ending Salary:Titles/Duties:Manager's name:Why did you leave? ReferencesList three professional references (not relatives or friends) whom you have worked with or been associated with for at least three years through school or volunteer work.#1 ReferenceRelationshipWork PhoneHome PhoneAddress City State / Province / Region #2 ReferenceRelationshipWork PhoneHome PhoneAddress City State / Province / Region #3 ReferenceRelationshipWork PhoneHome PhoneAddress City State / Province / Region Military ServiceBranch of ServiceDates of Service:Type of Discharge:Duties/Special Training:Education/SkillsHigh SchoolDid you graduate? Yes No GED Address Street Address Address Line 2 City State / Province / Region #1 College/UniversityDid you graduate? Yes No Degrees:Address Street Address Address Line 2 City State / Province / Region #2 College/UniversityDid you graduate? Yes No Degrees:Address Street Address Address Line 2 City State / Province / Region License/Certification NumbersRN:LPN:CMT:CNA:Other:Computer SkillsSoftware Applications:Hardware:Other Education/Skills:Acknowledgement*I certify that the answers given here are true and complete to the best of my knowledge. I understand that Bishop Spencer Place is an Equal Opportunity Employer and does not discriminate against any individual, applicant, or associate on the basis of sex, color, race, religion, disability, age, citizenship, veteran's status, national origin, ancestry, or sexual orientation. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at the employment decision. In the event of employment, I understand that false or misleading information given in my resume, application or interview may result in the offer being withdrawn or termination of employment. I understand that this application is not a contract of employment. I understand that the job I seek is an at-will position. If hired, I will be an at-will employee who may resign or have my employment terminated by Bishop Spencer Place at any time, with or without cause, and with or without notice. I acknowledge that Bishop Spencer Place is a drug-free workplace. I agree to abide by the terms of the Bishop Spencer Place's drug-free workplace policy if hired. I understand that I will be required to take a drug screen if offered employment. I also understand that all associates are subject to a drug and/or alcohol screen upon reasonable cause to suspect a violation of Bishop Spencer Place policy. I also acknowledge that Bishop Spencer Place does not hire individuals who use tobacco. I certify that I am not a current tobacco user and will not use tobacco products during my employment if I am employed by Bishop Spencer Place. I certify that I have listed all convictions on this application and I specifically certify that I have never been convicted of or pled guilty or no contest to a class A, B, or D felony, and that my name is not on any state's department of Social Services' employee disqualification list of those individuals who have been found to have abused or neglected elderly or handicapped patients, children or residents. I further certify that I have never been convicted of the crimes of "patient, resident, or client abuse or neglect" or of "furnishing unfit food to patients or clients" or of failing to report abuse or neglect in a convalescent, nursing, or boarding home. I understand that I am required to abide by all rules, regulations, and policies of Bishop Spencer Place. I also understand that I am expected to support the mission and values of Bishop Spencer Place. I agree NameThis field is for validation purposes and should be left unchanged.