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Job Application

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Date *

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of non-job-related medical condition or handicap, or any other legally protected status. 


Department

Select all that you wish to apply for.

Healthcare
Environmental Services
Other
Do you have a valid professional license or certification? *

Applicant Information

Are you currently employed? *
If yes, may we contact your employer? *
If employed and under the age of 18, can you furnish a work permit? *
Have you applied here before? *
Have you been employed here before? *
Are you prevented from lawful employment due to Visa or Immigration Status? (Proof of citizenship or Immigration Status will be required upon employment) *
At Stones River Manor, we do allow properly vaccinated animals. Do you see this being a conflict for you? *
Are you available to work (check all that apply): *
Are you available to work (check all that apply): *
What day can you start? *

Employment Experience

Start with your present or last job. Include military service assignments and or volunteer activities. You may exclude the organization names which indicate race, color, religion, gender, national origin, handicap, or other protected status. 

Start Date
End Date

Start Date
End Date

Start Date
End Date

References

Give name and contact information for three (3) personal references who are not related to you and are not previous employers.

I authorize Stones River Manor, Inc. to contact any and all former employers for verbal or written references about my employment. *

Education


Special Skills & Qualifications


Applicant's Statement

I do not have any communicable diseases or diseases of any type that could endanger the health or livelihood of any resident or coworker at Stones River Manor, Inc. I consent to required pre-employment and annual TB testing by Stones River Manor healthcare staff or an approved medical provider designated by Stones River Manor, if documentation has not been provided. I consent to pre-employment drug testing and authorize the release of said tests to Stones River Manor. Furthermore, I consent to random, reasonable suspension, and mandatory post on the job injury drug testing in accordance with the Tennessee Drug-Free Workplace Program. I authorize and consent to background checks of all references, past/current employment, education, and criminal history record which may be in any national, state, or local files including those maintained by both public and private organizations. I consent for an outside firm of Stones River Manor’s choice to assist in checking such information.


I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire whether or not applications are being accepted at that time. The applicant understands that neither this document nor any offer of employment from the employer constitutes an employment contract unless a specific document to that effect is executed by the employer and employee in writing. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.


I consent to the use of my electronic signature on this application as well as any other documents presented during the employment process with Stones River Manor. I recognize that my electronic signature holds the same weight and value as my handwritten signature.

Date *

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