Employment Application

Please provide your first name, middle initial, and last name. Example: Jane C. Doe
Please indicate what type of position you are applying for: CNA, CMA, Homemaker, Nurse, etc...
$
Please indicate your desired hourly salary.
Background Information
Prior Convictions
Convictions are evaluated by position and are not necessarily disqualifying.
Education
Skills Inventory
Employment History
Listing the most recent first, complete your employment record for at least the past five (5) years.
If employed, I understand that I must conform to the policies of Evergreen Community of Johnson County and to any departmental rules and regulations, and my employment and compensation can be be terminated with or without cause, and with or without notice, at nay time, at the option of either ECOJC or myself. I hereby certify that the information given on all pages of this application is true and correct. I understand that any answers contrary to the truth may be grounds for dismissal o refusal to hire and that nothing has been withheld that would affect my employment. I authorize my former employers, educational institutions and other persons or entities identified in this application to provide any and all information or documents about me to ECOJC. I hereby relieve all individuals connected with such release from liability for providing this information. If employed, I understand that I must furnish information required pertaining to birth-date, sex, race, citizenship, marital status and number of dependents and would agree to conform to the rules and regulations of Evergreen Community of Johnson County. I understand that all employees of ECOJC are subject to our random drug testing policy.
If you have a resume you'd like to attach, please do so.
Files must be less than 2 MB.
Allowed file types: pdf doc docx.