Erica Berry’s Employment Application

Application Date: 11/6/2023

Job Title: Assisted Living / Memory Care QMA

Job Location: West Lafayette

Personal Information

First Name: Erica

Last Name: Berry

Email: ad0xzg@r.postjobfree.com

Contact Information

Cell Phone: +1-765-***-****

Country: United States

State: IN

Address: 616 N 12th St

City: New Castle

Postal Code: 47362-4419

Application Questions

Who can we thank for referring you? If no one, please tell us how you heard about us. Indeed Have you ever worked for Westminster Village before? If yes, when and what was your last name? If no, please type no. No

Are you 15 years of age or older? Yes

Are you 18 years of age or older? Yes

Are you legally authorized to work in the United States? Yes Are you looking for full or part time work? Full Time Desired Compensation: $15 hourly

Have you ever been convicted of a crime? If yes, please explain. If no, type no. Yes I have been convicted of possession on 2 separate occasions and I have since sought out and completed treatment programs I understand if it is revealed that I have falsified any information on my application or my resume, it is grounds for termination. Yes

Applicant's Statement

Every new employee of Westminster Village must submit to a criminal background check, drug screen, physical examination and TB Test. Do you agree to follow through with these employment requirements? Yes I understand that nothing contained in this application or in the interview process is intended to create an employment contract between me and Westminster Village, West Lafayette LLC. If I am employed by Westminster Village, West Lafayette, LLC, I will be an employee-at-will. This means that both Westminster Village, West Lafayette, LLC and I have the right to terminate my employment at any time, for any reason, with or without cause. I also acknowledge that upon receiving an offer of employment, I will be required to successfully complete all pre- employment requirements such as a physical, PPD skin test, drug screen, background check, OIG and references. The facts set forth in my application for employment are true and complete. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal. You are hereby authorized to make any investigation of my personal history and financial and credit record through any investigative or credit agencies or bureaus of your choice. In making this application for employment I authorize you to make an investigative consumer report whereby information is obtained through personal interviews with my neighbors, friends or others with whom I am acquainted. This inquiry, if made, may include information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of any such investigative report that is made.

Acceptance: Yes

Signature: Erica Berry

By checking this box, you acknowledge and consent to terms of the privacy policy which applies to the applicant tracking service being offered by Paycor on behalf of Westminster Village, West Lafayette Inc.. The privacy policy offers an explanation of how and why your data will be collected, how it will be used and disclosed, how it will be retained and secured, and what legal rights are associated with that data (including the rights of access, correction, and deletion). The policy also describes legal and contractual limitations on these rights. The specific rights and obligations of individuals living and working in different areas may vary by jurisdiction. I have read and agree to this statement

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