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Application for Employment

Secure Care KY Application for Employment
Name *
Name
Address *
Address
Phone *
Phone
If hired, do you have reliable transportation? *
Do you have a valid driver license? *
Have you ever been arrested or convicted of a crime, including misdemeanors? *
Are you willing to submit to a drug test as part of the employment process? *
Are you willing to work various shifts (including weekends, nights, and holidays)? *
Education
Military Service Record
Have you ever served in the armed forces? *
Date of Duty From
Date of Duty From
Date of Duty To
Date of Duty To
References
Reference #1 *
Reference #1
Phone *
Phone
Reference #2 *
Reference #2
Phone *
Phone
Reference #3 *
Reference #3
Phone *
Phone
Work History
List in order, last, or present employer first
Address *
Address
Supervisor *
Supervisor
Address
Address
Supervisor
Supervisor
Address
Address
Name of Supervisor
Name of Supervisor
Disclaimer
Your employment with Secure Care, INC. is a voluntary one and is subject to termination by you or Secure Care, INC. at will, with or without cause, and with or without notice, at any time. Nothing in these policies shall be interpreted to be in conflict with or to eliminate or modify in any way the employment-at-will status of Secure Care, INC. employees. This policy of employment-at-will may not be modified by any officer or employee and shall not be modified in any publication or document. The only exception to this policy is a written employment agreement approved at the discretion of the President or the Board of Directors, whichever is applicable. These personnel policies are not intended to be a contract of employment or a legal document.
Applicant E-Signature *
Applicant E-Signature
Date *
Date
For Office Use Only
Interviewed By
Interviewed By
For Office Use Only
Date of Interview
Date of Interview
For Office Use Only
Date of Second Interview (If Applicable)
Date of Second Interview (If Applicable)
Date of Drug Screen
Date of Drug Screen
Date of Reference Check
Date of Reference Check
Date of Offer
Date of Offer
Date of Acceptance
Date of Acceptance