Employment Application Employment Application Step 1 of 4 - Contact Information 25% Facility Name*- Select One -Bella Point BridgtonBella Point CamdenBella Point FreeportBella Point FryeburgBayview ManorCrawford CommonsEast PointHilltop ManorThe Lamp Memory Care CenterThe Lodges Care CenterPleasant Meadows EstatesPrince PointRising HillSeal CoveTissues Country EstatesWellmore PointName First Last Email* Phone*Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employment DesiredPosition DesiredHow did you hear about this position?Desired Salary?Current Employer?May we contact your employer? Yes No Employer Phone AvailabilityDate you can begin workDo you have reliable transportation to and from work? Yes No Employment Schedule Full-Time Part-Time Per Diem Preferred Shift 1st (Days) 2nd (Evenings) 3rd (Overnights) Additional Availability Weekends Holidays Overtime On Call Employment History Include your last ten (10) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.Employment History:Employment History: Δ
