Employment Application Please fill out the below form to the best of your ability. Questions? Email the Human Resources Department at HR@RestHavenHomes.org. Latest Jobs on IndeedDietary Aide/Server - Part Time - Rest Haven Homes - Grand Rapids, MI View All Jobs on Indeed Name* First Last Phone*Email* Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you authorized to work in the United States?*YesNoHave you worked for this Rest Haven Homes before?*YesNoReason for leavingHave you ever been convicted of a crime?*YesNoDo you use tobacco products in any form?*YesNoAre you currently employed?*YesNoPosition Applying for*Nurse AideDietary AideCook / Prep CookOtherOther Position Applying for:Desired Shift(s) First Shift Second Shift Third Shift Interested in Full-time Part-time Who referred you?EDUCATIONAL BACKGROUNDEDUCATIONAL BACKGROUNDPlease list relevant Educational experience. Click the plus button to add more. Type of SchoolName and CityDid You Graduate?Course or Major PRESENT AND PAST EMPLOYMENTPRESENT AND PAST EMPLOYMENTClick the plus button to add more. Company NameDates WorkedCityPosition HeldReason for Leaving PROFESSIONAL / WORK REFERENCESPlease list anyone we might be able to call as a reference to past profession / work experience. Click the plus button to add more. NameCompanyRelationship / TitlePhone SkillsPlease check the skills for which you have received training: CNA Word Processing Data Entry CEU Classes Languages Awards/Recognition CPR Certification Other Languages:Awards / Recognition:CEU Classes:Other:Resume Upload (Optional)Accepted file types: pdf, doc, docx, jpg, png, jpeg.APPLICANT MUST READ AND SIGNIn compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status. I certify that I have read and understood all of this employment application. It is agreed and understood that the employer or his agents may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not, and I release employers and other persons or sources from all liability for any damages on account of furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination, drug test, nicotine test, and a background check. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated with or without cause, at any time, with or without notice and at will. I understand that Rest Haven Homes, Inc. is a tobacco free campus and does not hire persons who use tobacco in any form. Persons who come to work smelling like tobacco or smoke will forfeit the remainder of the shift and be subject to disciplinary action. I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with the employer and for no other reason. I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal. If hired, I agree to abide by all the rules and policies of the employer. Due to the nature of the work performed at Rest Haven Homes, Inc. it is required for employment that each applicant is able to read with understanding and write with clarity in English on all resident and job related documentation. This signature certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.Today's Date* Date Format: MM slash DD slash YYYY Signature*NameThis field is for validation purposes and should be left unchanged.