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WE'ei,

 

Serving Seniors Since 1945

An Equal Opportunity Employei'

STATEMENT OF NON-DISCRIMINATION

We at Walker are committed to a policy of equal treatment and opportunity without regard to race, color, creed, religion, national
origin, sex, marital steitus, status with regard to public assistance, sexual orientation, age, or disability (except when based on a
bona fide occupational quali?cation). This includes, but is not limited to: recruitment, hiring, selection for training, transfer,
promotion, rates of pay and other forms of compensation. -

 

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GENERAL INFORMATION
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CLERICAL APPLICANTS ONLY
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NURSING APPLICANTS ONLY
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OTHER INFORMATION



 

Volunteer and unpaid work experience which may relate to the
political group af?liation.

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Kind of Volunteer Activityzl Wad-kid PHI. :9

position for which you are applying. Do not include religious. ethnic.

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Your Title/Duties: 13-5

 

 

 

 

mamaexperience saineg?ajg than years 830. list only duration of experienceyears/months :1 m5 



 

completion of the orientation period.

or handbooks migh
the providing of any bene?t. No promises regarding employment

 

Date

 

FOR HUMAN RESOURCES USE ONLY

READ SIGNING

{understand and agree that any offer of employment is conditional upon completing and passing a medical screening based on the
physical demands of the job for which 1 am applying. acceptable reference checks. criminal background check. and successful

I authorize inVestigation of all statements contained in this application and I understand that misinformation given on my
employment application form and during the medical. screening is suf?cient cause for discharge, if am employed.

I understand that nothing contained in this employment application or in the granting of an interview or in any policies. procedures.
I receive. is intended to create an employment contract between Walker and myself for either employment or for

guarantee is binding upon Walker. If an employment relationship is established. I understand that I have the right to terminate my
employment at any time, for any reason, and Walker retains a similar right regarding the termination of my employment.

I WOULD LIKE TO RECEIVE A OF MY INVESTIGATIVE REPORT.

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have been made to me. and I understand that no such promise or

 

Signature of Applicant
Cl YES N0

 

 

interviewed 

I Date:

 

 

 

Results: 

 

 

 

 

Board of Nursing: Phone Veri?cation: Date:

Registered: Ci Yes El No

 

 

 

Comments:

Mantoufoapetwork Date:

 

. Position

 

 

Start Date:

Status:

 

 

 

 

Follow up letter number

Date sent:

 

1094