Employment Application

Employment Application

ARcare is an equal opportunity employer. Applicants requiring accommodations to the application should contact the Human Resources Department at 870-347-3466.

Each question should be answered completely and accurately.

No action will be taken on this application until all questions have been answered and the application has been signed and dated.

Full Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *

Confirmation Email

Position and Location applying for *

Desired Pay Range *

Can you travel if job requires? *

Yes No

Referral source

Are you over the age of 18? *

YES NO

Are you eligible to work in the United States? *

YES NO

Are you currently employed? *

YES NO

Date available for work *

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Have you been employed here before? *

YES NO

Have you plead "guilty" or "no contest " or been convicted of a crime? *

YES NO

If so, provide information *

If a professional license is held, has the license ever been disciplined or encumbered?

YES NO

If yes, please explain.

EDUCATION

Highest level of education completed: *

Please complete the appropriate sections

	Name & Location of School	Number of Years Attended	Did You Graduate?	Degree or Certification
GED / High School
Trade School
College
Graduate

WORK HISTORY

Please list your four most recent employers, list the most recent first

Have you been discharged or asked to resign by an employer? *

Yes No

If Yes, please explain

1. Employer

Employer's Name (Most current) *

Address & location of business *

Your title *

May we contact this employer? *

YES NO

Supervisor's name *

First and Last Name

Phone number *

Area Code Phone Number

Start date *

Month Day Year

End date

Month Day Year

Work performed: *

Reason for leaving *

2. Employer

Employer's Name (Second most recent) *

Address & location of business *

Your title *

May we contact this employer? *

YES NO

Supervisor's name *

First and Last Name

Phone number *

Area Code Phone Number

Start date

Month Day Year

End date

Month Day Year

Work performed: *

Reason for leaving *

3. Employer

Employer's Name (Third most recent)

Address & location of business

Your title

May we contact this employer?

YES NO

Supervisor's name

First and Last Name

Phone number

Area Code Phone Number

Start date

Month Day Year

End date

Month Day Year

Work performed:

Reason for leaving

4. Employer

Employer's Name (Fourth most recent)

Address & location of business

Your title

May we contact this employer?

YES NO

Supervisor's name

First and Last Name

Phone number

Area Code Phone Number

Start date

Month Day Year

End date

Month Day Year

Work performed:

Reason for leaving

ADDITIONAL INFORMATION

Do you have a U.S. military service record? *

YES NO

If yes, branch of service *

Discharge date and rank *

List job-related skills and qualifications, accomplishments and awards. (Exclude information that would reveal race, color, national origin, religion, gender, age, marital, or veteran status; medical condition, disability; or any other legally protected status.)

List any additional information you would like us to consider:

REFERENCESList three references, (not relatives) that you have known for at least one year.

1. Full Name *

First Name Last Name

Company *

Best phone number to reach them *

Area Code Phone Number

Years acquainted *

Relationship *

2. Full Name *

First Name Last Name

Company *

Best phone number to reach them *

Area Code Phone Number

Years acquainted *

Relationship *

3. Full Name *

First Name Last Name

Company *

Best phone number to reach them *

Area Code Phone Number

Years acquainted *

Relationship *

I understand that ARcare is making no employment offer at this time. I certify that the information in this application is correct to the best of my knowledge. I understand that any misrepresentation or omission of any fact in my application, resume, or any other materials, or during interviews is grounds for disqualification from further consideration for employment or for termination, if employed.I authorize ARcare to contact any company, institution, or individual it deems appropriate to investigate my employment history, character, qualifications, credit history, driving record, and other relevant information, if job-related. I give my full consent for all contacted individuals, including former employers, to provide information concerning this application, and I waive my right to bring any cause of action against these individuals for any and all liability for damages arising from furnishing the requested information to ARcare. I acknowledge that a facsimile and/or photocopy of this form is as valid as the original.I understand that if hired, employment is at-will, regardless of the employer, and may be terminated by myself, the employer or ARcare at any time, with or without cause or notice, for any reason or no reason. You must agree to accept the terms of the document in order to submit an application. By entering your name, you agree to accept the terms of the above document with an electronic signature. *

I agree I do not agree

Type signature *

Date *

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