Employment Application - Windward Life Care

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Employment Application

Position Applied For:*
Name*
First Last
Address*
Street Address City State ZIP Code
How should we address you? You may select more than one by pressing SHIFT + clicking your selections.
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
Employer One
Employer
From
To
Job Title
Address
Street Address City 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 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 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

Contact Us

Windward Life Care®

AgingWell@WindwardLifeCare.com

Physical Address:
2045 1st Avenue
San Diego, CA 92101
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Windward HOME HEALTH:
1635 Lake San Marcos Drive, Suite 201-A
San Marcos, CA 92078

Mailing Address:
PO Box 87371
San Diego, CA 92138

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HCO License #374700238
CDPH License #550004925

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