Employment Application Step 1 of 9 11% Your Personal InformationYour Name First Last Your Email Address Enter Email Confirm Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Your PhoneBest Time To Call YouBest Time To Call YouMorningsEarly AfternoonLate AfternoonEarly Evening Your Personal Information ContinuedPosition You're Applying For (Be Specific)Monthly/Hourly Salary desired:Are you under 18 years of age? Yes No Last 4 of your Social Security Number:Will you work overtime if asked? Yes No Have you ever applied for employment at Canyon Rim Assisted Living? Yes No If Yes, Please listMonthYearLocation Add RemoveHave you ever been employed by Canyon Rim Assisted Living? Yes No If Yes, Please listLocationDates of EmploymentLast SupervisorReason For Leaving Add RemoveDo you have the legal right to be employed in the United States?(If offered a position, the Immigration Reform & Control Act of 1986 requires you to furnish proof of your employment authorization and your identity before you can begin work.) Yes No Your Personal Information ContinuedHow did you learn of our organization? Craig's List Company Website Indeed Job Fair Other Employee Referral Please list where you heard of us Add RemoveDo you have any commitments to another employer that might affect your employment with us? Yes No Please list Add Remove Essential Job FunctionsAre you able to perform the essential functions of the position(s) for which you have applied? Yes No please explain or request a job description for clarification of essential functions of the position(s).please explain or request a job description for clarification of essential functions of the position(s). Add RemoveIf required for the position for which you are applying, are you willing and able with or without reasonable accommodation to lift objects weighing up to 50 lbs? Yes No Upon the company's receipt of an appropriate health care provider's note explaining a lifting restriction, a temporary waiver from lifting requirements may be provided to employees who have special needs due to medical conditions. Position You're Applying ForHours You Are Available for WorkPlease tell us what hours you are available for work each day of the week.MondayTuesdayWednesdayThursdayFridaySaturdaySunday Add RemovePrevious EmploymentYour Previous EmployersPlease list your previous employers, the dates you worked and the position you heldEmployerPositionDatesAddressPhoneSupervisor NameSupervisor PhoneReason For LeavingMay we contactResponsibilities Add Remove ReferencesReferencesList THREE professional references that are familiar with your work performance. Do NOT list family or friends.NameRelationshipEmail AddressPhone Number Add Remove Background ChecksAny employment offer made is contingent upon passing an acceptable background check through the Department of Human Services CRIMS, reference checks, verification of past employment, and acceptable MVR (if applicable to the position for which you applied), and pre-employment drug test and eligibility to work in the United States as governed by the Department of Homeland Security.Have you ever had a claim of substantiated abuse found against you? Yes No If Yes, list date of case, state and facility/location:If Yes, list date of case, state and facility/location: Add RemoveAre you currently under investigation for a case of abuse? Yes No If Yes, list date of case, state and facility/location:If Yes, list date of case, state and facility/location: Add RemoveHave you ever had a license or certification revoked for any reason? Yes No If Yes, list date of case, state and facility/location:If Yes, list date of case, state and facility/location: Add Remove More About YouTell Us About YourselfUpload Your ResumeUpload your resume in .pdf, .doc or .docx formatAccepted file types: pdf, doc, docx, Max. file size: 100 MB. Applicant's Certification, Agreement and AuthorizationCertification, Agreement, and AuthorizationI authorize Canyon Rim Assisted Living and their agents to conduct a thorough investigation of my past employment, education, and activities, and I agree to fully cooperate in such investigation. I certify that the statements indicated on this Application and any resume or supplementary materials provided are true and complete to the best of my knowledge and I understand that falsification or omission of any information Elite Care considers material will result in refusal to hire or termination of my employment, if I am hired. The Application for Employment is not a contract and cannot create a contract. If employed by Canyon Rim Assisted Living, I agree to abide by its rules and regulations as they currently exist or are subsequently modified. I understand that my employment would be “at-will” and could be terminated at any time by either party, with or without cause, and with or without notice. Further, I understand and acknowledge that there can be no change in this “at-will” relationship unless it is in writing, specifically addressing the “at-will” relationship, and it is signed by the President of the Company. I agree to the privacy policy. A Small CommunityWith Big Experiences. The local choice for assisted living in Wasco, Wheeler, and Sherman Counties. Head Office 1701 George Jackson RdMaupin, OR 97037 Call Us (541) 395-2515 EMAIL US canyonrim@vandahealth.net
