Oasis Adult Day Services

Application for Employment

Oasis Adult Day Services provides equal employment consideration without discrimination based on race, color, religion, sex, age, national origin, disability, or any other status protected by law. Information provided in this application will be kept confidential and reviewed only for employment purposes.

Applicant information

Full legal name *Email address *Phone number *Street address *City *State *ZIP code *Best time to contact

Emergency contact

Name *Relationship *Phone number *

Position and availability

Position applying for *Date available to start *Hours available per week *Days and times available *How did you hear about Oasis?

Are you legally authorized to work in the United States? * Yes No

Do you have reliable transportation to work? * Yes No

Do you have a valid driver license? * Yes No

Education

Highest level completed *School name *Degree, program, or area of study

Employment history

List your two most recent employers. If you have no employment history, enter “N/A.”

Employer 1

Employer name *Employer phoneJob titleSupervisorStart dateEnd dateReason for leavingMain duties

Employer 2

Employer name *Employer phoneJob titleSupervisorStart dateEnd dateReason for leavingMain duties

Qualifications and references

Relevant skills, training, licenses, or certifications

Professional reference 1Name *Phone *Professional relationship *

Professional reference 2Name *Phone *Professional relationship *

Applicant certification

I certify that the information in this application is complete and accurate to the best of my knowledge. I understand that false or misleading information may disqualify me from employment or result in termination. I authorize Oasis Adult Day Services to contact the employers and references listed above.

I have read and agree to the statement above. *

Typed full name as signature *Date *

Do not enter Social Security numbers, banking information, medical records, passwords, or copies of identification in this form.

Human verification

Complete Google’s “I’m not a robot” check before submitting. An image challenge may appear when additional verification is needed.

Oasis will review the application and follow up. For questions, call (513) 429-5012.