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WHAT WE OFFER
Aging Life Care® Management
Consultation Services
Care at Home
Windward Home Health
FAQ
WHO WE ARE
Why Windward Life Care
Meet Our Team
Our Locations
Home Care Aide of the Quarter
Windward in the Community
CAREERS
NEWS
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Employment Application
Position Applied For:
*
Name
*
First
Last
Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
How should we address you? You may select more than one by pressing SHIFT + clicking your selections.
She/Her
He/Him
They/Them
Other
If you selected other, please specify:
Do you have a name other than the one listed above you'd like us to call you by?
Phone
*
Email
*
Date Available
Desired Salary
How were you referred to our company?
Do you have a valid driver's license and current auto insurance?
*
Yes
No
Do you have a reliable means of transportation?
*
Yes
No
Have you ever been employed here before?
*
Yes
No
Do you have the legal right to work and be employed in the U.S.? (Proof of identity and legal authority to work in the US is a condition of employment.)
*
Yes
No
EDUCATION
Name of High School
Degree
Graduated?
Yes
No
Name of College
Degree
Graduated?
Yes
No
Other Training
Degree
Graduated
Yes
No
PLEASE LIST ALL EMPLOYMENT IN THE PAST 7 YEARS, starting with the most recent:
Number of employers in the past 7 years
1
2
3
4
Employer One
Employer
From
To
Job Title
Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Immediate Supervisor and Title
Nature of the work and duties?
Average Hours a Week?
May We Contact This Employer?
Yes
No
Reason for Leaving?
Employer Two
Employer
From
To
Job Title
Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Immediate Supervisor and Title
Nature of the work and duties?
Average Hours a Week?
May We Contact This Employer?
Yes
No
Reason for Leaving?
Employer Three
Employer
From
To
Job Title
Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Immediate Supervisor and Title
Nature of the work and duties?
May We Contact This Employer?
Yes
No
Reason for Leaving?
PLEASE READ CAREFULLY, INITIAL EACH PARAGRAPH, AND SIGN BELOW
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection or withdrawal of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
Initial
*
I hereby authorize Windward Life Care to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records,without giving me prior notice of such disclosure. In addition, I hereby release Windward Life Care, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigations or disclosure.
Initial
*
I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and Windward Life Care. In addition, I understand and agree that if I am employed, my employment is at will, for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of myself or Windward Life Care. No promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the President of Windward Life Care.
Initial
*
Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgement) be conducted by internal personnel employed by the Company, I am entitled to copies of any such public records obtained by the Company if I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have not checked the box below.
Initial
*
I would like a copy of any public record described in the paragraph above.
Yes
Date
Date Format: MM slash DD slash YYYY
Applicant's Signature