Please read carefully, ask questions about anything you don’t understand.

At‐Will Employment

Serenity Assisted Living maintains an At‐Will Employment arrangement with all employees. I understand that if hired, the employment will not be permanent; instead the employment will be At‐Will meaning that either party may terminate this agreement at any time, with or without cause, at‐will.YesNo

Dependent Care

If hired, I understand due to the nature of the business, (taking care of dependent people) I will have dependent people, and my co‐workers relying on me to come to work when scheduled and on time, unless I am prevented to do so because of illness or emergency. In the event I am not able to come to work, I will immediately make a reasonable attempt to find my own replacement as well as notify the administration. I further understand, that although this employment relationship is At‐Will that I am not allowed to walk away from my job, and leave the residents unsupervised at anytime. This can be considered a vulnerable adult violation and appropriate action will ensue.YesNo

Physical and Mental Ability

I understand that due to the nature of the business, (taking care of dependent people) I must always have the physical and mental ability to do the job. If I am disabled, or become disabled, I understand that I can request the company to make reasonable accommodations to assist me, however, the company may refuse if it compromises resident care, or causes an undue hardship on the company.YesNo

Visiting After Termination

If hired, I understand that this facility reserves the right to refuse to allow me to come back to visit at the facility after termination of employment.YesNo

Drug & Alcohol Policy

I understand that prior to my acceptance of employment, and if hired, during my employment, I may be tested for the use of illegal drugs, and if found positive for use, my relationship with Serenity Assisted Living will be immediately terminated. I further understand that if hired, and I am found under the influence of drugs or alcohol while at work, I may be immediately terminated.YesNo

Non‐Discrimination Policy

I understand this company does not discriminate against applicants because of race, creed, color, religion, gender, or sexual preference, and that hiring is based on qualifications, personal characteristics, background check and interview.YesNo

Conditional Hire

I understand my employment status with Serenity Assisted Living, if hired, is conditional until my criminal background check clears, I pass medication administration training and testing, or discovery of a criminal conviction.YesNo

Information Verification I hereby give my permission for Serenity Assisted Living to contact my previous employers, schools and other contacts I have listed here and hereby release this company, and listed contacts from any liability arising from such communication of information. I understand that falsification of this information is just cause to refuse hiring, and falsifications discovered later, can be grounds for immediate termination.

Signature

Date

Employment

An Equal Opportunity Employer

Applicant Information

Check which shifts you are available to work

Personal Information

Education Background

High School

College

OTHER TRAINING, VOCATIONAL OR MILITARY PROGRAMS

Work Experience

Employer 1

Employer 2

Employer 3

Experience, Skills, Qualifications, and Talents

Application Acknowledgements

Verification