Vernon Advent Christian Home

Application form

Fill out the online form below or download our pdf application form, which you can print and mail.

Vernon Advent Christian Home is an equal opportunity employer and is firmly committed to prohibiting discrimination throughout the employment process against individuals because of race, color, sex, sexual orientation, gender identity, age, religion, national origin, ancestry, place of birth, military status, positive HIV-related blood test, or against qualified individuals with disabilities, or because of any other legally protected status.

Title of job applied for:

Date:

Full Name (Last, MI, First):

Mailing Address:

City, State, Zip Code:

Permanent Address (if different from mailing):

Home Phone:

Work Phone:

E-mail address:

Yes

Statements (Check either "Yes or No" for each question)

Are you 18 years of age or older?

Have you previously been employed by Vernon Advent Christian Home?
If yes, when?

Supervisor:

Reason for leaving:

Do you have any relative or any other person(s) residing with you, who is employed by Vernon Advent Christian Home?
If yes, Name:

Relationship:

Have you been convicted of a crime?
If yes provide explanation with dates

Position Interest / Availability

Check the type(s) of employment you are interested in:
Full-Time Part-Time Temporary All

Check the shifts you are willing to work:
Day Shift Night Shift Evening Shift Any Shift

Do you have reliable transportation? Yes No

How many miles away do you live?

Anticipated rate of pay:
$ per hour

How did you hear about employment at Vernon Advent Christian Home?

Why have you considered employment at Vernon Advent Christian Home?

What are the two most important factors to you in choosing a job?
1.

2.

Date you are available?

Did a current employee refer you to us? Yes No
Employee's Name

Are you legally eligible for work in the United States Yes No

Can you provide appropriate documentation?: Yes No

Education/Training History

Name and location of last school attended:

Dates Attended:

Fields of Study (major, minor):

Highest Grade Completed:

Degree Earned and Year:

Yes No Do you have a high school diploma or GED certificate?

Yes No Are you currently enrolled in a course of study?
What?

Where?

Employment History

A resume will not substitute for the following information. List employment starting with your current or most recent position; include service in the U.S. military, if applicable. Account for any time during this period that you were unemployed by stating the nature of your activities.

Job Title:

Employer:

Type of Business:

Address:

Phone #:

Employment from, to:

Starting hourly pay:

Ending hourly pay:

Supervisor's name:

Duties:

Reasons for leaving:

May we contact this employer?:
Yes No

Employer 2

Job Title:

Employer:

Type of Business:

Address:

Phone #:

Employment from, to:

Starting hourly pay:

Ending hourly pay:

Supervisor's name:

Duties:

Reasons for leaving:

May we contact this employer?:
Yes No

Employer 3

Job Title:

Employer:

Type of Business:

Address:

Phone #:

Employment from, to:

Starting hourly pay:

Ending hourly pay:

Supervisor's name:

Duties:

Reasons for leaving:

May we contact this employer?:
Yes No

Professional License

Description (e.g.Registered Nurse):

License Number:

State:

Expiration Date:

Personal References

Please list three individuals not related to you who may know of your work qualifications and can serve as a reference for you.

Name and Title or Relationship:

Full Address:

Phone:

Name and Title or Relationship:

Full Address:

Phone:

Name and Title or Relationship:

Full Address:

Phone:

In submitting this application,

I authorize Vernon to thoroughly investigate my employment history and activities. I agree to cooperate in such investigation, including the release of information from my personnel files of former or current employers. I release from all liability or responsibility all persons, companies or corporations supplying such information.
I understand that an offer of employment is contingent upon a satisfactory background check, which includes checks of the state child abuse registry, state adult abuse registry, 50 state criminal registry, the Office of Inspector General, and if applicable, the Department of Motor Vehicles. I further understand that background checks will be conducted on a regular basis throughout any period of employment with Vernon Advent Christian Home.
I understand that an offer of employment is contingent upon my satisfactorily passing a physical examination before date of hire.
I understand and agree that employment with Vernon Advent Christian Home is at-will, which means either party is free to terminate the employment relationship at any time for any reason or for no reason.
I certify that statements made on this application and attachments (if any) and/or during the interview process are true and complete and that nothing has been withheld that would affect this application. I further understand that any false statement will result in rejection of this application, and if employed, dismissal.

Name: Date:

Vernon Advent Christian Home Statement of Values
We will create "A community of caring that you can call home" by:

Serving those in our care with compassion and zeal

Regarding every employee as a vital part of our mission

Respecting human worth and dignity

Being honest and ethical in all our actions

Pursuing excellence and exceptional value in all our work

Embracing change and innovation as an opportunity for growth