Employment Application - Rehab at Shannondell

Personal Information
Name*
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Primary Phone*
Alternate Phone
Age*
Are you under the age of 18?
- No
- Yes
Yes
If yes, tell us your date of birth.
MM slash DD slash YYYY
Citizenship*
Are you a U.S. citizen or legally authorized to work in the U.S.?
- Yes
- No
Criminal History*
Have you ever been convicted of a crime? Include all pleas of "guilty" or "no contest". This information will not necessarily bar an applicant from employment and, therefore, any uncertainty should be resolved in favor of disclosure.
- No
- Yes
Explain*
If yes, please explain fully.

Professional References
Please list at least three people you know professionally that we may contact in reference to your application.
Reference Name*
Relationship to Reference*
peer, supervisor, etc.
Email
Phone*
Reference Name*
Relationship to Reference*
peer, supervisor, etc.
Email
Phone*
Reference Name*
Relationship to Reference*
peer, supervisor, etc.
Email
Phone*

Legal Considerations
Applicant Release and Acknowledgement: My signature below certifies that all statements and information given herein are correct and accurate. I understand that any false answers or statements made by me on this application, any supplement thereto or in connection with the above-mentioned investigations may be grounds for refusal of employment, invalidate my employment or, if employed, grounds for immediate discharge. In consideration of Shannondell' evaluation of my suitability for employment, I hereby authorize Shannondell to perform all checks of my credentials as allowed by law including, but not limited to, discussions with employers, supervisors, co-workers, friends, business associates, or other individuals that Shannondell in its sole discretion, believes may have relevant information regarding my suitability for employment. I further authorize Shannondell to perform the following checks on my credentials; State Criminal Record Check and/or Federal Bureau of Investigation Criminal Background Check, and such other checks as Shannondell deems appropriate. I agree to complete any post-offer physical evaluations that Shannondell may require including a pre-employment physical and testing for illegal or unauthorized substances. I understand that any offer of employment is contingent upon my successfully passing the physical evaluation requirements and the background investigation. I agree not to assert any claims or causes of action of any kind against Shannondell, its agents, its employees, or any individuals or companies contacted by Shannondell as part of its investigation, from any and all claims, demands, damages, actions, causes of action, or suits of any kind of nature whatsoever arising from Shannondell’s investigation of my credentials. I acknowledge that Shannondell has made no representation of any kind as to whether employment will be offered at conclusion of its investigation. If I am offered and accept employment with Shannondell, I agree to abide by the rules and the policies of Shannondell and understand that my employment is at will and terminable at anytime for any reason either by myself or by Shannondell. My signature below acknowledges that I have read and understand the entire application and agree to the terms and conditions outlined above.
Applicant Name*
Applicant Signature (Typing your name here constitutues your signature.)
Submission Date*
Date (date of submission)
MM slash DD slash YYYY

Rehab at Shannondell

Employment App

Step 1 of 6

Personal Information

Employment Request

Employment History

Education and Training

Professional References

Legal Considerations