Tammie Taylor’s Employment Application

Application Date: 2/2/2023

Job Title: Environmental Service Assistant/Housekeeping Job Location: Bridgeport

Personal Information

First Name: Tammie

Last Name: Taylor

Email: adzusl@r.postjobfree.com

Contact Information

Cell Phone: 304-***-****

Home Phone: n/a

Country: United States

State: WV

Address: 2 Carmichael court

City: Clarksburg

Postal Code: 26301

Application Questions

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General Information

Have you worked under any other names? (If no, type N/a): N/A Are you 18 years of age or older? Yes

Are you legally authorized to work in the United States? Yes Due to the COVID-19 Vaccine Policy, a COVID-19 vaccine is now required for employment at this facility. Are you vaccinated? : Yes

If no, are you willing to be vaccinated? n/a

How did you hear about this opportunity? Indeed

If referred by a current employee, please give employee name. n/a Are there any reasons you would not be able to perform the essential functions of the position you are applying for? No

If yes, please describe: n/a

What is your preferred work location? Clarksburg

What is your 2nd choice for work location? Bridgeport What is your minimum rate desired? Open

What shift are you interested in? Days

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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

Job Title: n/a

Employer Name: n/a

City: n/a

State or Province: n/a

Currently Employed? n/a

Start Date: n/a

End Date: n/a

Have you ever worked for a AMFM facility? No

If yes, which facility? (If no, type N/a): N/A

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Education/Training

What is your highest level of education completed? High School/GED Name of institution(s): Stanley vo tech

Graduate? Yes

Major(s): Ged

Degree(s) or Certification(s): n/a

List any professional licenses: I was an CNA for over 35 years, I had two clients for 11 years I couldn't use that to keep my license

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Applicant's Statement

This facility does not discriminate in hiring on the basis of race, color, sex, citizenship, national origin, ancestry, Vietnam era veteran status, or on the basis of age or physical or mental disability unrelated to ability to perform the work required. No question on this application is intended to secure information to be used for such discrimination.I voluntary give this institution the right to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release all liability or responsibility all persons, companies or corporations supplying such information. I consent to take the physical examination, and such future physical examinations as may be required by this institution at such times and places as the institution shall designate. I understand that an offer of employment may be contingent on passing the physical examination, which relates to the essential duties I would be required to perform.I understand that my employment is at will, and that either party is free to terminate the employment relationship at any time without cause. I also understand that my employment may be terminated for any misstatement or omission of fact appearing in this application form.By providing my cell phone number to COMPANY, I agree and acknowledge that COMPANY may send text messages to my cell phone number for any purpose, including job marketing purposes. I agree that these texts/calls may be regarding the job positions that I have previously inquired about, and job positions that COMPANY may market to me. I acknowledge that this consent may be removed at my request but that until such consent is revoked, I may receive text messages from COMPANY at my cell numberIf employed, I will be required to complete an Employment Verification Form (I-9), and within three days show satisfactory evidence of identity and eligibility for employment.I further understand that employment will be contingent on passing a WVCARES background screening. Acceptance: Yes

Signature: Tammie Taylor

Check the box below if you would like to receive text messages from the company regarding your status in the hiring process. Data rates may apply. I am happy to receive text messages from American Medical Facilities Management. 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 American Medical Facilities Management. 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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