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Application for Employment

 

Advantage Management, LLC. operates under the philosophy of non-discrimination for all employees regardless of race, origin, color, religion, gender, marital status, sexual preference, veteran status, or disability. Employment decisions will be made on the basis of competency and compliance to state or national licenser and/ or certification. A criminal background check is required by the State of Wisconsin, the results of which may prohibit employment under State of Wisconsin DHS 83 regulation. Care staff employees are required to be at least 18 years of age.

 

                       
Personal Information
Placement and Shift Preferences - Select all that apply
CBRFRCAC
Beaver DamWaupun
Full-TimePart-TimeCasual
1st Shift 6am-2pm2nd Shift 2pm-10pm3rd Shift 10pm-6am
Additional Comments Regarding Placement and Shift Preference
YesNo
YesNo
YesNo
YesNo
This company provides care for our resident's twenty-four hours a day, seven days per week. All staff members are required to work weekends and holidays on a rotation basis. You may also be asked to fill in for absent co-workers from both our facilities. Are you available to work under these conditions?
YesNo
Employment History
Education
Fire SafetyFirst Aid TrainingMedicationsDietary NeedsStandard PrecautionsResident Rights
CNAPCWDementia Experience
References
List references in addition to your previously listed employers:
Disclaimer and Signature
I acknowledge that the above information is truthful and I authorize Advantage Management, LLC. to investigate this information by contacting my present or former employers and listed references.
I understand that Advantage Management reserves the right to perform random drug testing on all employees at any time. A positive test will result in termination of the employment agreement between Advantage Management and myself.
Authorization for Release of Information
For official use only, not to be released to unauthorized persons
hereby empower an employee of Advantage Management, LLC. or other authorized representative thereof bearing this release to obtain information and records, within one year of the date of this release, pertaining to me from any or all of the following sources:
1. Municipal, State, or Federal law enforcement agencies or personnel
2. Any banking institution
3. Any place of business (for purposes of obtaining credit or employment data)
4. Credit rating bureaus or institutions
5. Any previous employer
6. Present employer
7. Any school, college, university, or other educational institution
8. Selective Service System
Exceptions to this blanket authorizations:
1. Any medical information in the possession of any source named above until subsequent to a conditional offer of employment (per Americans with Disabilities Act).
This release is executed to authorize Advantage Management, LLC. as a prospective employer, to obtain the above information. It is understood that said information shall be used only in consideration of my employment and shall not be further disseminated for any purpose.