8211 Weller Road Montgomery, Ohio 45242
Your idea of a Nursing Home is about to Change...
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Home Phone: Work Phone: Mobile Phone:
What Position are you applying for?
Have you been employed by Meadowbrook Care Center before? NO YES
Dates of Employment: Department:
Are you related to anyone presently employed by Meadowbrook? No Yes - If Yes, who?:
Have you ever been convicted of a crime? No Yes - If Yes, please explain:
Have you ever been injured at work? No Yes
Do you have a valid Ohio Drivers License? No Yes
Do you have a valid C.D.L.? No Yes
Are you a US citizen? No Yes If No, Visa Class:
Are you available to work rotating shifts if the position you are applying for requires it? No Yes
Are you a veteran of the United States Military Service? No Yes - Branch: Dates: Please fax official documents certifying honorable veteran's status to 513-247-2943
Education
Computer Skills: (check all that apply)
Word Excel Publisher Access
ACT! Outlook
Give name, address and telephone number of three references who are not related to you and are not previous employers.
Trinity Healthcare Corporation is an Equal Employment Opportunity Employer
TRINITY HEALTHCARE IS AN EQUAL OPPORTUNITY EMPLOYER. No person employed by Trinity or seeking employment with the organization shall be appointed, promoted, reduced, removed, or in any way favored or discriminated against because of political or religious opinion or affiliations, race, color, sex, national origin, or physical handicap. The submittal of this document via e-mail constitutes your acknowledgment that the information provided is true to the best of your knowledge. Any misrepresentations will be reason for dismissal.
I agree that any false statements in this application will be sufficient cause for rejection or dismissal. I hereby grant permission to investigate any of the statements in this application and to submit to a medical examination if required. The use of this application does not indicate positions are open and does not obligate Trinity Healthcare.
For More Information or a Tour... 513-489-2444
Meadowbrook is a proud supporter of the Trinity Foundation International
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Wednesdays at 6:30 pm - Channel 24;
Thursdays at 9:00 am - Channel 4; on Time Warner Cable
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