APPLICATION FOR EMPLOYMENT
Thank you for considering Acumentra Health in your job search. Acumentra Health is an equal employment opportunity employer and does not discriminate on the basis of race, age, color, sex, national origin, physical or mental disability, marital or veteran status, sexual orientation, or any other classification protected by law. No application will be rejected as a result of disability that, with reasonable accommodation, does not prevent performance of the essential job duties. After completing the application click on the "Submit Application" link at the bottom of the page.
1. Personal Information
Position Applied For:
Date You can Start::
2. Education and Skills
3. Work Experience
May we contact your present employer? Yes
4. General Information
|Are you 18 years of age or older?
Do you have the legal right to work in the United States?
applicants will be required to prove identity and eligibility for employment.)
|Have you ever been employed or attended school using any other name?
|If yes, please explain.
Have you ever been
convicted, plead Guilty, or No Contest, or Forfeited Bond or
Bail for any crime other than traffic violations?
|If yes, please explain.
|Conviction of a crime is not an automatic bar from employment. Factors such as
the nature and gravity of the offense, whether it is job related and when it occurred will be considered.
Are you able to perform the primary duties of the job as outlined in the newspaper
advertisement, posting, job description, announcement, etc., with or without
If no, please explain.
|Do you have any employment restrictions resulting from a non-compete or confidentiality
|PLEASE USE THE SPACE BELOW TO PROVIDE ANY ADDITIONAL INFORMATION
(For example, specific skills, additional employers, periods of time
not worked, etc.)
PLEASE READ VERY CAREFULLY BEFORE SIGNING.
I certify that I have answered the above questions truthfully and have not withheld any information relative to my application. I understand that any falsification, misrepresentation, or omission, as well as any misleading statements or omissions of the application information, attachments, and supporting documents generally will result in denial of employment or immediate termination, if discovered after hire.
I understand that any questions regarding this statement should be directed to Acumentra Health's Human Resources Manager before I sign below. I understand that this application will be given every consideration, but its receipt does not imply that I will be employed.
It is the policy of Acumentra Health to afford equal opportunity to all employees and applicants without regard to race, age, religion, color, sex, national origin, physical or mental disability, marital or veteran status, sexual orientation, or any other classification protected by federal, state or local law.
I authorize Acumentra Health, or its third party, to conduct any necessary investigation concerning my employment and employment practices and behavior, current and past.
I authorize Acumentra Health to investigate whether I have a criminal record of convictions, and, if so, the nature of such convictions and all the surrounding circumstances of the conviction. Acumentra Health has advised me that any criminal background check will focus on convictions, and that a criminal record will not necessarily disqualify me from employment.
If hired, I agree to abide by the rules and policies of Acumentra Health. I understand that my employment and compensation can be terminated at any time, with or without cause, and with or without notice, at the option of Acumentra Health or myself. I understand that the president is the only person who will ever have the authority to create any other terms of employment and/or to enter into any employment contract and that all such contracts must be in writing and signed by both parties. However, I also understand that unless otherwise stated in an employment contract, the company may change, withdraw and interpret other policies (including wages, hours, and working conditions) as it deems appropriate.
I acknowledge reading and understanding the foregoing statements.
Confidential -- For Statistical Use Only
Acumentra Health is an Equal Opportunity Employer and does not discriminate on the basis of race, age, religion, color, sex, national origin, physical or mental disability, marital or veteran status, sexual orientation, or any other classification protected by federal, state or local law. The information below will be used only in compilation of data for Affirmative Action reporting.
Position applying for:
(not of Hispanic origin)
Please identify where you learned about this employment opportunity with Acumentra Health:
State Employment Office
Referred by Acumentra Health employee
School placement center
Other Newspaper (Please specify)
Other (Please specify)
Attach Resume and Submit Application
Please submit your resume by clicking on the "Browse" button below. Locate your resume file and click "Open". Once you have selected your resume and completed the application, click the "Submit Application" button. If you choose not to submit a resume, simply click the "Submit Application" button.
Note: Please incorporate your first and last name in the file name of you resume document. Example "ResumeBill_Smith.doc"