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Courtney Douglas’ Employment Application

Application Date: 9/22/2022

Job Title: Caregiver/Aide P/T for The Arbor

Job Location: 3002 Westward Dr., Nacogdoches, TX

Personal Information

First Name: Courtney

Last Name: Douglas

Email: advjyx@r.postjobfree.com

Contact Information

Cell Phone: +1-936-***-****

Country: United States

State: TX

Address: City: Postal Code: 401 75961 . Application Questions

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General Information

Are you 18 years of age or older? Yes

Are you legally authorized to work in the United States? Yes Have you ever been convicted or pled "no contest" of any misdemeanor or felony involving theft, violence, breach of trust, dishonesty, crimes for which the terms of your sentence or probation currently prohibit or restrict your contact with minors, or the illegal manufacture, sale, distribution, or trafficking of drugs? You need not disclose juvenile or adult conviction records that have been expunged or sealed. Conviction of a crime is not an automatic bar to employment, and all circumstances will be considered. No Desired Compensation: $12 hourly

Available Start Date: 9-26-2022

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How If employee did you referral, hear about please this give opportunity? employee name: . n/a

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Employment History

Please provide the following requested information regarding your employment history: Include military service assignments and volunteer activities. You may exclude organization names that include race, color, religion, gender, national origin, ancestry, age, disability or other protected status. Current or Most Recent Employer

Are you currently employed? No

Employer City Title: Start and Date: State: Name: 8-5-2021 ' . End Date: 9-16-2022

Reason for Leaving: Laid Off

Explanation: n/a

Rate of Pay: 8.00

Direct Company Supervisor: Phone: 936-***-**** OK to contact? Yes

Responsibilities - ' and Duties:, . Education/Training

What is your highest level of education completed? Some College Institution Graduate? Name No s): Major(Degree(- s)s): : & List - any professional licenses:

Applicant's Statement

I certify that my answers to all questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application or during the pre-employment process may be grounds for my immediate termination. Acceptance: Yes

Signature: 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 WindRiver Companies. 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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