Application For Employment
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.
General Information (*required field)
spam Name:
spam Subject:
*Position Applied For:
*Location Applying To:	Smith Crossing
*Application Date
How did you hear about us?	Advertising     Relative Agency Friend Inquiry Other Current Employee Name:
I am currently employed by Smith communities and am interested in a new opportunity by applying for a posted job opening.
*First Name
*Last Name
Middle Initial
*Address
*City
*State	AK AL AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA SC SD TN TX UT VT VA WA WV WI WY        Zip
*Home Phone
Mobile Phone
Other
Email
*Best time to contact you at home	Any day Mondays Tuesdays Wednesdays Thursdays Fridays Saturdays Sundays    Anytime Noon 1:00 1:30 2:00 2:30 3:00 3:30 4:00 4:30 5:00 6:00 6:30 7:00 7:30 8:00 8:30 9:00 9:30 10:00 10:30 11:00 11:30    AM PM
*If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No   *Have you ever filled out an application with us before? Yes No If yes, give date? *Have you ever been employed by Smith Senior Living, Smith Village, Smith Crossing or Smith Cares? Yes No If yes, give date? *Do any of your friends or relatives, other than spouse, work here? Yes No   *Are you currently employed? Yes No   *May we contact your present employer? Yes No   *Are you prevented from lawfully becoming employed in this country because of visa or immigration status? Proof of citizenship or immigration status will be required upon employment Yes No
*Date available for work What is your desired salary range? to
Are you available to work Full Time Please indicate 1st 2nd 3rd Shift   Part Time Please indicate Mornings Afternoons Evenings   Temporary From to
*Are you currently on "lay-off" status and subject to recall? Yes No Can you travel if a job requires it? Yes No *Have you ever been convicted of a felony? A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question. Yes No
Education
Elementary School Name and Address of School Course of Study Years Completed Diploma/Degree High School Name and Address of School Course of Study Years Completed Diploma/Degree Undergraduate College Name and Address of School Course of Study Years Completed Diploma/Degree Graduate or Professional School Name and Address of School Course of Study Years Completed Diploma/Degree Other (Specify) Name and Address of School Course of Study Years Completed Diploma/Degree Detail your specialized training, apprenticeship, skills and extra-curricular activities. Describe any job-related training received in the United States military. List professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancesitry, disability or other protected status.
Employment Experience
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disability, or other protected areas.
1 Employer   Address   Telephone Number   Job Title   Supervisor   *Reason for Leaving   *Dates Employed From: to   Hourly Rate/Salary Starting: Ending: Work Performed 2 Employer   Address   Telephone Number   Job Title   Supervisor   Reason for Leaving   Dates Employed From: to   Hourly Rate/Salary Starting: Ending: Work Performed 3 Employer   Address   Telephone Number   Job Title   Supervisor   Reason for Leaving   Dates Employed From: to   Hourly Rate/Salary Starting: Ending: Work Performed
Additional Information
Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.
Specialized Skills	(Check Skills / Equipment Operated)
Microsoft Office	Word Outlook Access Excel PowerPoint Publisher   Short Hand Word Processing EMR WPM
Equipment	Copier Fax Alcatel
Other
State any additional information you feel may be helpful in considering your application.
Note to applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE JOB REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given. Yes No
References	1 Name   Phone   Address   City   State AK AL AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA SC SD TN TX UT VT VA WA WV WI WY    Zip
	2 Name   Phone   Address   City   State AK AL AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA SC SD TN TX UT VT VA WA WV WI WY    Zip
	3 Name   Phone   Address   City   State AK AL AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA SC SD TN TX UT VT VA WA WV WI WY    Zip
*I have read and agree to the Applicant's Statement

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