ONLINE EMPLOYMENT APPLICATION

PART 1 OF 5

IMPORTANT: Please note that this web application sometimes fails to submit data.

Until we are able to fix this problem, we ask all applicants to confirm their application via email.

When you have submitted your application, please send a followup email to Victoria Jones (victoria.jones@bivinshomes.org) which includes:


You will receive a confirmation letting you know whether or not your application was successfully submitted.

We apologize for any inconvenience this may cause you.

Contact Information


* First Name:   
Middle Name:   
* Last Name:   
* Address 1:   
Address 2:   
* City:   
* State:   
* Zip:   
* Phone:   
Email:   
* Social Security Number:   

Application Cover Letter
You may submit a resume on the next page


You can type in a Cover Letter or Copy/Paste from an existing document.

Application for Employment


PERSONAL INFORMATION

*  Are you legally eligible to be employed in the United States?  (Proof of identity and eligibility will be required upon employment):    Yes  No
*  Are you at least 18 Years of age?:    (If no, you may be required to provide authorization to work) Yes  No
*  Have you ever been convicted of a crime (Misdemeanor and/or Felony)?  (Conviction does not necessarily preclude your employment)    Yes  No
If so, when, where and for what?    
Have You Ever Been Employed With Mary E. Bivins Foundation?     Yes  No
If So, When?    

EMPLOYMENT DESIRED


 Where are you applying to?       Bivins Memorial
Childers Place
E.J.B. Cullinary Center
Bivins Villages
*  When Are You Available To Work?
*  Type of Employment Desired:    Full Time
Part Time
PRN
*  Hourly Rate/Salary Desired:   
*  Are you currently employed?:    Yes No
If so may we inquire of your present employer?:    Yes No
If presently employed, why are you considering leaving?:   
Position Desired:   
Shift Desired:   
How Did You Learn Of This Position    Newspaper
Billboard
TV
Radio Ad
Internet
Other
Employee 
Referred By:   

EMPLOYMENT HISTORY


Give your full employment record starting with your current or most recent employment.

Company Name Start Date End Date
     
Street Address, City, State, Zip
 
Position Title Company Phone Number Immediate Supervisors Name and Title
     
Job Description and Responsibilities:
 
Starting Salary Ending Salary Reason for Leaving
     
May we contact for reference?  Yes  No

Company Name Start Date End Date
Street Address, City, State, Zip
Position Title Company Phone Number Immediate Supervisors Name and Title
Job Description and Responsibilities:
Starting Salary Ending Salary Reason for Leaving
May we contact for reference? Yes  No

Company Name Start Date End Date
Street Address, City, State, Zip
Position Title Company Phone Number Immediate Supervisors Name and Title
Job Description and Responsibilities:
Starting Salary Ending Salary Reason for Leaving
May we contact for reference? Yes  No

EDUCATION

Give record of all High Schools, Colleges, Universities and Vocational /Technical Schools you have attended.

School Name & Location

Did you Graduate? Degree Received Subjects Studied/Major
Yes No
Yes No
Yes No
If you have completed any special courses, seminars and/or training that would help you to perform the position for which you are applying, please describe:

Professional References


Please provide three professional references (not relatives).

Name:    Relationship Phone Number

Professional License


Please provide any professional licenses or certifications.

LVN License:   
RN License:   
CNA:   
Other:   

I understand that emergency conditions may require me to temporarily work shifts other than the one for which I am applying and agree to such scheduling change as directed by my superior of this institution.

Check this box to certify that you have read and accept the above statement.

If your availability status changes, it is your responsibility to notify your supervisor or the administrator. Such changes will be effective, then for any future employment.


I understand that this application will remain active for a maximum of 30 days.  If I have not been offered employment within these 30 days and wish to be considered further, it will be necessary for me to re-apply when Bivins Homes are accepting application.

Check this box to certify that you have read and accept the above statement.


This institution does not discriminate in hiring or any other decision on the basis of race, color, gender, citizenship, national origin, veteran status, or on the basis of age or physical or mental disability to perform the work required.  No questions on this application are intended to secure information to be used for such discrimination.

I voluntarily give this institution the right to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release all liability or responsibility all persons, companies or corporate supplying such information.  I consent to the complete health screen, including background screen and drug screen as may be required by this institution at such times and places, as the institution shall designate.  I understand that a continued offer of employment may be contingent on passing the health screen, including background screen and drug screen, which relates to the essential duties I would be required to perform.

I acknowledge that if hired, I will be an at will employee.  I will be subject to dismissal or discipline without notice or cause, at the discretion of the employer.  I understand that no representative of the company, other than the president, has authority to change the terms of an at will employment and hat any such change can occur only in a written employment contract.  I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form.

If employed, I will be required to complete an Employment Verification Form (I-9), and within three days show satisfactory evidence of identity and eligibility for employment.

Check this box to certify that you have read and accept the above statement.