Employment Application

Application for Employment

Emory Valley Center is an equal opportunity employer and no applicant shall be discriminated against on the basis of race, color, religion, sex, age or national origin. Emory Valley Center is a Smoking/Tobacco/Drug Free Workplace.

Step 1 of 4

Are you a Veteran?*
Have you ever worked at EVC before?*
Personal
Full Name*
First Last
Have you ever been adjudged civilly or criminally liable for abuse?*
- Yes
- No
Permanent Address*
Street Address Address Line 2 City State ZIP Code
TN Drivers License Number*
Are you taking any educational course(s) presently?*
- Yes
- No
- I will be soon
If Yes or you will be soon, what and where?
Position Applied For:*
Date Available*
MM slash DD slash YYYY
Email*
Home Phone
Cell Phone*
Where did you attend high school & college? (Click the + button to add a new row)*
School Name & Address Major Years Completed GPA Degree/Diploma
Do you have the legal right to live and work in the U.S.?*
- Yes
- No
Please check computer skill level:*
- None
- Basic
- Intermediate
- Advanced
Have you ever served in the U.S. Armed Services?
- Yes
- No
US Military Duties and special training
Rank held at discharge
Availability*
- Full time
- Part time
- Either
Times Available*
Check all that apply.
- Day Shift (8 a.m.- 4 p.m.)
- Evening Shift (4 p.m. – 12 a.m.)
- Night Shift (12 a.m. – 8 a.m.)
- Peaks (4 hour shifts – day or evening)
- Weekends (Fri. 4 p.m. – 12 a.m., Sat.-Sun. 8 a.m.- 12 a.m.)

Acknowledgement
Emory Valley Center and designated representatives are hereby authorized to investigate the information reported above, including the use of a criminal background check, and consumer credit reports. Furthermore, I understand that if employed, false statements in this application shall be considered sufficient cause for dismissal. The information disclosed above is true and complete to the best of my knowledge, and I understand that employment with Emory Valley Center is contingent upon the following: -PASSING A MEDICAL DRUG SCREENING -OBTAINING MEDICAL VERIFICATION OF NEGATIVE TB SKIN TEST AND/OR X-RAY -OBTAINING MOTOR VEHICLE REPORT AND OBTAINING F ENDORSEMENT (if prospective employee's duties include driving) -OBTAINING VERIFICATION OF REQUIRED CREDENTIALS (High school diploma, GED, College Diploma or Transcript) -ACCEPTABLE EMPLOYMENT HISTORY, PERSONAL REFERENCES, AND CRIMINAL BACKGROUND CHECK, INCLUDING DEPARTMENT OF INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (DIDD) REQUIRED REGISTRY CHECKS. (Fingerprinting sample may be required) I understand that this application is not an employment contract. I understand that Emory Valley Center is an employer-at-will and that my employment may be terminated at any time, with or without notice and with or without cause. if I am exposed to information concerning the physical or mental health status, condition, or treatment of any person during the pre-employment process, I agree to keep any and all such information confidential. I understand that this obligation applies regardless of whether or not I am hired by EVC. I have read the above statement and I confirm my understanding by signing below.
Signature*
Date
MM slash DD slash YYYY
Resume Upload (optional)
Accepted file types: doc, docx, pages, odt, rtf, tex, txt, wpd, wps, pdf, Max. file size: 128 MB.
If you have a resume you'd like to attach, please do so here. This is not required.
Phone
This field is for validation purposes and should be left unchanged.

Name	Address	Phone Number	Occupation	Years Known

Employment Application

Application for Employment

Step 1 of 4

Personal

References

Employment History

Acknowledgement

Contact Us

School Name & Address	Major	Years Completed	GPA	Degree/Diploma

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