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Application for Employment

REQUIRED READING BEFORE FILLING OUT YOUR

APPLICATION FOR EMPLOYMENT

Evenglow will not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. Evenglow will endeavor to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex or national origin. Such action shall include, but not be limited to the following: employment, upgrading, demotion , or transfer; recruitment or recruitment advertising; layoff; termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship

Also, Evenglow will not discriminate against any employee or applicant because of sexual orientation, citizenship status, age, marital status, disability with respect to qualified individuals with disabilities as described in the Americans with Disabilities Act, military status, or unfavorable discharge from military service, ancestry, or on the basis of any characteristic protected by applicable law.

Our Equal Employment Opportunity policy covers all employment practices, including, but not limited to, employment, upgrading, hiring, benefits, promotions, discipline, training, and termination. If you have any questions or concerns about the Company’s Equal Employment Opportunity policy, please contact your supervisor, the Department Head, or the Human Resources Department.

REASONABLE ACCOMMODATION

Evenglow will make reasonable accommodation for a qualified employee with a disability/handicap unless doing so would result in undue hardship to the Company. Suggestions and questions about accommodation for disability/handicap are strongly encouraged; such an employee should discuss such accommodation issues with Human Resources as soon as practicable.

APPLICATION FOR EMPLOYMENT

Please Print

PERSONAL DATA

 Yes No
 Yes No

JOB DATA

 Days Evening Nights Weekends Holidays
 Full Time Part Time Registry* PRN

I certify that I am a citizen or national of the United States, or an alien lawfully admitted to permanent residence or an alien who is authorized by the Attorney General for employment in the United States. I understand if hired, I will be required to present documents for evidence of identity and employment authorization before I can start working at Evenglow.

EDUCATIONAL BACKGROUND

  • List the three (3) latest schools attended, starting with the most recent
  • List number of years completed
  • Indicate degree, diploma or certification earned, if any.

LICENSE AND CERTIFICATION INFORMATION

 Yes No

REFERENCES - List business/professional persons known, but not related to you, other than listed in the employment history section.

EMPLOYMENT HISTORY

Provide the following information of your past and current employers, starting with the most recent. Explain any gaps in employment in the comment section below.

FromTo
 Yes No
StartingLast
 Full Time Part Time
FromTo
 Yes No
StartingLast
 Full Time Part Time
FromTo
 Yes No
StartingLast
 Full Time Part Time

I hereby respectfully request that each of the above-named employers of mine to furnish the necessary and appropriate information sought by Evenglow at 215 E. Washington St., Pontiac, IL 61764 and authorize its releaseto Evenglow in good faith without penalty or liability.

List any relatives or friends working for Evenglow

 Yes No
 Yes No
 Yes No

If "yes", please describe the conviction in detail. A conviction will not necessarily result in your not being hired.

PLEASE READ AND INITIAL EACH PARAGRAPH BELOW (If there is any part of this page you do not understand, please ask the interviewer about it before initialing and signing).

I hereby authorize Evenglow Lodge ("Evenglow") investigate my references, work records, education and other matters related to my suitability for employment at Evenglow and, further, authorize my current and former employers to disclose to Evenglow in good faith any and all letters, reports and other information pertaining to my employment with them, without giving me prior notice of such disclosure. In addition, I hereby release Evenglow Lodge from any and all claims, demands or liabilities arising out of or in any way related to such investigations or disclosure.

I understand that if offered employment, the offer may be contingent on my passing a preemployment alcohol and drug screen and a pre-employment physical. By signing this application, I voluntarily agree to submit to a pre-employment alcohol/drug screen and pre-employment physical upon request. I understand that failure to pass the alcohol/drug screen and/or physical will result in withdrawal of the employment offer.

If hired, I also agree to submit to alcohol and/or drug testing as a condition of employment, I agree that Evenglow Lodge may conduct alcohol and/or drug screening within its sole discretion with or without notice at any time. I also understand that my refusal to submit to alcohol/drug screens will be considered a failure to pass the drug and/or alcohol screen(s) and will result in my termination.

I understand that nothing contained in the application or conveyed to me during any interview which may be granted is intended to create an employment contract, implied or explicit, between me and Evenglow Lodge. In addition, I understand and agree that if I am employed, my employment relationship with Evenglow Lodge is strictly voluntary and at will. I understand that if employed, my employment is for no definite period and may be terminated at any time, with or without notice, with or without cause or reason, at the option of either myself or Evenglow Lodge, and that no promises or representations contrary to the forgoing are binding on Evenglow Lodge unless made in writing and signed by the President/CEO and myself.

I understand and agree that any future changes in my title, duties, compensation, working conditions, and/or Evenglow Lodge benefits, policies and procedures will not alter the atwill status unless made in writing and signed by the President/CEO and myself.

I understand that if offered employment, I will, as a condition of employment, be required to submit proof of my identity and legal right to work in the United States prior to my first day of employment.

If the position applied for requires driving in the course of work, I understand that I am required to possess a current and valid Illinois driver's license and understand that I will be required to provide a copy of my official driving record. I also understand that any offer of employment is contingent on my obtaining coverage by Evenglow's vehicle insurance carrier, if required for my position.

I authorize to have my driving record checked if the position for which I am applying requires driving.


I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement on this application or on any documents used to secure employment shall be ground for rejection of this application or for discharge if I am employed, regardless of the time elapsed before discovery.

Please Read and Initial on the line

I understand and agree that changes in the job duties, responsibilities, work schedule may occur during my employment.

I understand that any information on this application or on any document used to secure employment if found to be false, incomplete or misrepresented in any respect, will be ground for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I further certify that I, the undersigned, have personally completed this application and that all information listed on the application is true and complete.

My signature below certifies that I have read and understand this document, and agree to the terms and conditions outlined in it.

 

Evenglow Employment Questionnaire

  1. What prompted you to apply for a position at Evenglow?
  2. List training, experience that you feel you have to offer to our RESIDENTS and TEAM?
  3. Members of our TEAM classified as hourly do not miss work unless they have promptly and properly notified their department with a valid and verifiable reason. Will you comply with our Absenteeism/Tardiness policy?
  4. Please add any additional information to help us with our decision.