Apply for Independent Living Aide (ILA) CNA/BHT - On-Call Pool

Please fill out the information below and click on the Submit button Fields with an asterisk (*) are required.

Summary
Title:Independent Living Aide (ILA) CNA/BHT - On-Call Pool
ID:1412
Schedule:On call
Location:Valleywide
FSL Location:N/A
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
* Veteran Status:
Application Information
* Source:
If referral, provide name:
If other, provide source:
Attachments
Resume:
Supported formats: Word, PDF, RTF, Text, and HTML.
  - or Upload from:
 
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
ILA Screening Questions Archive
* Do you meet the job requirement of having high school diploma or GED?:
High School Diploma
GED
I do not have either
* Do you meet the job requirement of having a valid Arizona driver's license?:
Yes
No
* Do you meet the age requirement of being 21 years of age or older?:
Yes
No
* Do you meet the requirement of having 1 year experience with adults ONLY with serious mental illness, behavioral health issues, or developmental disabilities (NOTE: experience with Alzheimer's, dementia, etc., DOES NOT MEET THIS REQUIREMENT)?:
Yes
No
* Are you able to work the shift(s) indicated, and attend mandatory two weeks of training, from Mon- Fri: 8 am - 5 pm?:
Yes
No
* Are you a licensed CNA in the State of Arizona?:
Yes
No
* Do you have a Caregiver Certificate?:
Yes
No
If you have a Caregiver Certificate, please enter the Date Issued
Application for Employment
IMPORTANT!!: INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED. All fields of our application MUST BE FILLED OUT ENTIRELY, even if a resume is also provided. Please DO NOT just refer us to your resume to obtain the information. Thank you.
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 21 years or older? (If no, you may be required to provide authorization to work):
Yes   No
* Do you have a valid level 1 fingerprint clearance card from the State of Arizona?:
Yes   No
* Have you ever been denied a Fingerprint Clearance Card?:
Yes   No
* Can you travel locally if the job requires it?:
Yes   No
* Can you travel outside of Maricopa County if the job requires it?:
Yes   No
* Have you ever been discharged from any employment or asked to resign?:
Yes   No
If Yes, please explain:
* Have you ever been convicted of a felony or a misdemeanor? (A conviction will not necessarily result in the denial of employment):
Yes   No
If Yes, please explain:
* Have you ever worked for this Company before?:
Yes   No
If Yes, please provide details (Where/When/Job Title):
* Do you have any friends or relatives employed by Foundation for Senior Living?:
Yes   No
If yes, please provide their names and relationship to you:
* Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?:
Yes   No
If no, please explain:
* Please tell us why you want to work at FSL:

EMPLOYMENT DESIRED
* When would you be available to begin work?:
* Type of employment desired:
Full-Time
Part Time
On-call
* 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?:

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:

EMPLOYMENT HISTORY
Give your full employment record, starting with your current or most recent employment. Please DO NOT refer us to RESUME.

EMPLOYER 1

Dates Employed Employer Name & Address Employer Phone
From:
*

To:
*
*

*
*
Job Title Supervisor Name & Title May we Contact?
*
*

*
*
Yes
No
Responsibilities Reason for Leaving Salary/Hourly Rate
*
*
Start:
*

End:
*

EMPLOYER 2

Dates Employed Employer Name & Address Employer Phone
From:
*

To:
*
*

*
*
Job Title Supervisor Name & Title May we Contact?
*
*

*
*
Yes
No
Responsibilities Reason for Leaving Salary/Hourly Rate
*
*
Start:
*

End:
*

EMPLOYER 3

Dates Employed Employer Name & Address Employer Phone
From:
*

To:
*
*

*
*
Job Title Supervisor Name & Title May we Contact?
*
*

*
*
Yes
No
Responsibilities Reason for Leaving Salary/Hourly Rate
*
*
Start:
*

End:
*

REFERENCES Please provide three professional references (not friends/relatives).

Name Professional Relationship Phone Number Email
*
*
Ex Co-Worker   Colleague   Supervisor   Ex- Supervisor    Other
*
*
*
Ex Co-Worker   Colleague   Supervisor    Ex Supervisor   Other
*
*
*
Ex- Coworker   Colleague   Supervisor    Ex Supervisor    Other
*

AUTHORIZATION
The facts set forth in this application and any supplemental information are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the company to hire me. If I am hired, I understand that either the company or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of the company has the authority to make any assurance to the contrary.

Please Note: some of our funding sources require a fingerprint clearance by the Arizona Department of Public Safety. If you are hired for a position that requires fingerprint clearance, you will be asked for your clearance card (if you have one) or you will be fingerprinted on or before your first day of work.

I understand that I am required to abide by all rules and regulations of the company.

* Signature (type name):
* Date:

EQUAL OPPORTUNITY EMPLOYER
I understand that the Foundation is an Equal Opportunity/Affirmative Action employer and that applications are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, sexual orientation, veteran status, disability, status related to public assistance, and any other legally protected status.

I agree that, should an employment offer be extended to me and accepted, I will fully adhere to the policies, rules and regulations of employment of the Foundation.

I understand that neither the policies, rules, regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an implied employment contract.

I understand that, if employed, my employment is considered "at will" and may be terminated with or without cause, and with or without notice, at any time, at the option of either the Foundation or me.

Questions regarding these statements should be directed to the Foundation Human Resources department or to a Foundation employment interviewer before signing.

I acknowledge that I have read and understand the above statements.

Reference Authorization

I hereby authorize any of my former employers or personal references to furnish the Foundation for Senior Living and its affiliated corporations with any information they may have regarding my former employment and/or professional practices. I hereby release such employers or personal references from any and all liability of whatever kind, which, at any time, could result from the information provided.

Notice & Disclosure to Employment Applicant Regarding Procurement Of a Consumer Report

As part of its employment screening and selection procedures, the Foundation for Senior Living and affiliate corporations require a background and reference check for employees. The objective of the investigation is to verify the accuracy of the information provided through the application process, check references and identify other factors that might be relevant to Foundation for Senior Living and affiliate corporations' employment requirements. Prior to being hired and during the course of your employment, if hired, we may obtain a consumer report and/or an investigative consumer report about you for employment purposes. This report may include, but is not limited to: Department of Motor Vehicles, current and former employers, credit reporting agencies, military records, school records, professional and personal references, criminal conviction records, information regarding your character, experience, work habits, previous job performance, and the reasons for termination at previous places of employment.
Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The Information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
* Gender:
Female
Male
I Choose Not to Respond
* Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
Black or African American (Not Hispanic or Latino)
Hispanic or Latino
Asian (Not Hispanic or Latino)
White (Not Hispanic or Latino)
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
Two or More Races (Not Hispanic or Latino)
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Disabled Veteran
Newly Separated Veteran
Active Duty Wartime or Campaign Badge Veteran
Armed Forces Service Medal Veteran
I am a Protected Veteran, but choose not to self-identify the classification to which I belong
I am not a Protected Veteran
I decline to self-identify

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