Online Application For Employment

Thank you for your interest in employment at Maple Manor Nursing Home.  Your privacy is important and all information collected on the online application is private and confidential.  Please use the following form and upon submitting your information, a Maple Manor Nursing Home representative will be in contact with you.

For detailed information email our administrator (click here) or call 507-282-9449 x1018.
 

  
 
Personal Information
      *Required fields
Last Name*      
First Name*      
Middle Initial*      
Telephone*  
Email
Street Address*  
Street Address (Apt #, Suite)
City*      
State*      
Zip Code*      
       
Educational Information
 
Type of School Name & Location of School Number of Years Degree of Certificate
High School
Vocational Training
College or University
 
Employment desired
     
Position desired*    
Date you can start    
Desired salary    
Approximately how many hours per week would you like to work? 
Are you available to work weekends? Yes  No  
Are you available to work AMs? Yes  No  
Are you available to work PMs? Yes  No  
     
Nursing Applicants Only
       
Nursing Assistant Registration State:       Date: 
Minnesota RN/LPN License Number:         Expiration Date: 
       
Employment History   Starting with your most previous employer, please provide the following information:
 
Dates Employer/Company Position Salary / Rate Reason for Leaving
From:

To:

Employer/Company Name
Address of Employer/Company
Supervisor Name
From:

To:

Employer/Company Name
Address of Employer/Company
Supervisor Name
From:

To:

Employer/Company Name
Address of Employer/Company
Supervisor Name
From:

To:

Employer/Company Name
Address of Employer/Company
Supervisor Name
If presently employed, may we contact your employer?  Yes  No
Were you ever discharged or requested to resign from any position?   Yes  No
                                                   If yes, the reason?
     
Special Questions
       

Are you prevented from becoming lawfully employed in the U.S.?    Yes  No

Have you ever been convicted of a felony or misdemeanor that involved assault, child or spouse abuse, theft, damage to person or property, or dishonesty?    Yes  No

If you answered yes to the above and convicted of a felony, provide the following:

Date:  Jurisdiction:  

Description:
       
Personal References      Please do not list relatives or former employers
 
Name Address Occupation Telephone
       

Read the following disclaimer before submitting the online application for employment:

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information that may have, personal and otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand and agree that, if hired, my employment with Maple Manor Health Care and Rehabilitation is for no definite period and may, regardless of date of payment of my wages and salary, be terminated at any time without any prior notice.  I also understand that I may resign at any time.

By initialing the box below and submitting this online application for employment, I acknowledge that I have read and agree to the above disclaimer.

*Enter initials into box:     (first and last name initials   ie.  James Rockford =  JR)
 

 

  
 

 

  
     
 
 
  © 2010 Maple Manor Nursing Home. All Rights Reserved
   Terms & Disclaimer