Application for Employment

All questions contained within this Application for Employment are to be answered. The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to programs, services and employment is available to all persons. Any applicant requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resource Department.




Referral Source:























Enter Telephone Number in 555-555-5555 format.

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Are you legally eligible for employment in this country?


If you are under 18, can you obtain working papers?



If no, please explain:


Have you been employed with Redstone Highlands, Redstone@Home and/or Senior Independence before?


If yes, dates:  /   /       /   / 



Will you work overtime if required?


If no, please explain:


Have you been charged or convicted of any crime including misdemeanor offenses excluding summary offenses?


If yes, provide the following details:
Date, charge, place, disposition, court, action taken, sentence.


Do you have any founded actions of abuse or have you been convicted of any offense related to the abuse, neglect, or mistreatment of any clients, residents, or others?


If yes, provide all information regarding the founded actions.


Do you have a current driver's license?



List the names of all relatives working for Redstone Highlands, Redstone@Home and/or Senior Independence. Type in NONE if not applicable.