Apply Here — Cura Health

We are committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of race, color, religion, creed, national origin or ancestry, sex, age, physical or mental disability, veteran or military status, genetic information, sexual orientation, marital status, or any other legally recognized protected basis under federal, state or local laws, regulations or ordinances. The information collected by this application is solely to determine suitability for employment, verify identity and maintain employment statistics on applicants. Applicants with disabilities may be entitled to reasonable accommodation under the terms of the Americans with Disabilities Act and certain state or local laws. A reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity without imposing undue hardship on the United Methodist Homes. Please inform the United Methodist Homes’ Human Resources representative if you need assistance completing any forms or to otherwise participate in the application process. Please provide complete information. An incomplete application may affect your consideration for employment.

Name

First Name

Last Name

Current Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

Country

(###)

###

####

Cell Phone

Country

(###)

###

####

Which facility are you interested in?

Are you legally authorized to work inn the U.S.?

Yes

Do you now, or will you in the future, require immigration sponsorship for work authorization (e.g., H- 1B)?

(if hired, verification will be required consistent with federal law.)

Yes

Are you at least 18 years old? (if no, you may be required to provide authorization to work)

(if no, you may be required to provide authorization to work)

Yes

How did you hear about us?

Have you worked for any Cura Health location before?

Yes

If yes, list dates employed:

From

YYYY

To:

YYYY

If yes, what was your job title?

Do you have any relatives employed by Cura Health?

Yes

If yes, list name and title:

POSITION INFORMATION

Type of work desired:

Salary Range Expected:

Date Available to Start:

YYYY

EDUCATION

School/Institution Name:

City, State, Country

Did You Graduate?

Number Years Completed:

Major/Area of Study:

Minor:

List any work related certifications or licenses you currently possess:

EMPLOYMENT RECORD

List all employment experience for the past seven years, starting with the most recent or present employer, including US Military Service. Using a separate section for each position, describe in detail all work experience including periods of unemployment. You may include as part of your employment history any verified work performed on a volunteer basis. Please include a separate sheet of paper if additional space is necessary.

Name of Employer 1

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Job Title

Start Date

YYYY

End Date

YYYY

Supervisor's Name

First Name

Last Name

Supervisor's Title

Description

Reason For Leaving

May We Contact?

Yes

Employer Phone Number

(###)

###

####

Name of Employer 2

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Job Title

Start Date

YYYY

End Date

YYYY

Supervisor's Name

Supervisor's Title

Description

Reason For Leaving

May We Contact?

Yes

Employer Phone Number

(###)

###

####

PROFESSIONAL REFERENCES

List three professional references (other than those listed as current/former supervisor) that we may contact. If you don’t have references readily available to you now, you may provide them at the time of interview.

Reference #1

First Name

Last Name

Phone

(###)

###

####

Company Name

Reference #2

First Name

Last Name

Phone

(###)

###

####

Company Name

BACKGROUND INFORMATION

In the past 7 years, have you ever been discharged, suspended or asked to resign from any position?

YES

If YES, please explain:

For the purposes of verifying information on this application, have you ever worked or attended school under a different name at any of the organizations you have listed?

YES

If YES, please specify name

For Pennsylvania Applicants: have you been a resident of the Commonwealth of Pennsylvania for the past two (2) years without interruption?

YES

Before completing this section, please read the State Specific Notices below. Answering "Yes" to the question below will not automatically bar you from employment. Only those crimes which are substantially related to the position will be considered.

New York Applicants: You may answer "no record" concerning any criminal proceeding that terminated in your favor, per section 160.50 of the New York Criminal Procedure Law; any criminal proceeding that terminated in a "youthful offender adjudication," as defined in section 720.35 of the New York Criminal Procedure Law; any conviction for a "violation" that already has been sealed by the court, per section 160.55 of the New York Criminal Procedure Law; and any conviction that was sealed pursuant to section 160.58 of the New York Criminal Procedure Law in connection with the licensing, employment or providing of credit or insurance. It a discriminatory practice for any employer to deny employment to any individual by reason of his or her having been convicted of one or more criminal offenses, when such denial is in violation of the provisions of Article 23-A of the New York Correction Law. It is the policy of this Company to not discriminate against applicants who have a criminal record. A criminal conviction does not result in an automatic disqualification from employment. All applicants are examined on a case-by-case basis, taking into account a series of factors the Company is required to review. The Company will take into consideration the specific duties and responsibilities of the position the applicant is applying for, and the bearing, if any, the criminal conviction might have on the applicant’s fitness or ability to perform one or more duties or responsibilities.

Pennsylvania Applicants: Do not identify convictions for summary offenses. Have you ever been convicted of a crime that has not been expunged, sealed, pardoned, annulled, statutorily eradicated or dismissed upon condition of probation? You are not required to disclose sealed or expunged records of conviction or arrest, or expunged juvenile records of conviction or arrest.

YES

If you answered "Yes," to the previous question, please provide county and state of conviction and the date and nature of the offense, along with any sentencing information. Felony and misdemeanor convictions may be considered by an employer only to the extent to which they relate to the applicant's suitability for employment in the position for which he or she has applied. The employer shall notify in writing the applicant if the decision not to hire the applicant is based in whole or in part on criminal history record information.

PLEASE READ EACH PARAGRAPH CAREFULLY BEFORE SIGNING

I have disclosed all information that is relevant and should be considered applicable to my candidacy for employment. I understand, where permissible under applicable state and local law, I may be subject to a pre- employment drug test after receiving a conditional offer of employment, and must receive a negative result for illegal drug use before being permitted to commence work with United Methodist Homes. I understand, where permissible under applicable state and local law, I may be subject to a pre- employment medical examination after receiving a conditional offer of employment, and must meet the qualifications for the position, with or without reasonable accommodation, before being permitted to commence work with United Methodist Homes. I understand, where permissible under applicable state and local law, I may be subject to a pre-employment background check after receiving a conditional offer of employment to investigate my criminal background and other matters related to my suitability for employment. I hereby certify that the information given by me is true in all respects. I authorize United Methodist Homes and its representatives to contact my prior employers and all others (with the exception of my current employer, only if I have marked "May we contact your present employer" on this applicable as "No") for the purpose of verification of the information I have supplied and release same from any liability resulting from the information released. I authorize, employers, schools and other persons named on this application to provide any information or transcripts requested. I understand employment with United Methodist Homes is also contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States. If employed, I understand that as a condition of employment that I may be required to agree to and sign a non-solicitation, non-disclosure, and/or other similar agreements. I also agree to notify the organization during the pre-employment process of any non-solicitation, non-disclosure, and/or other similar agreements that I may have already signed with current and former employers. I expressly understand and agree that, if employed, my employment, having no specified term, is based upon mutual consent and may be terminated at will, with or without cause, by either party (United Methodist Homes or me) without prior notice to the other, unless otherwise prohibited by law. I understand that no representation, whether oral or written, by any representative or agent of United Methodist Homes, at any time, can constitute an implied or express contract of employment unless it is memorialized in a document signed by the CEO of United Methodist Homes. I further understand no representative or agent of United Methodist Homes has the authority to enter into an agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other terms or condition of employment other than in a document signed the CEO of United Methodist Homes. I understand that the technical processing and transmission of the application, including my personal information, may involve (a) transmissions over various networks, including the transfer of this information to the United States and/or other countries for storage, processing and use by United Methodist Homes, its affiliates, and their agents; and (b) changes to conform and adapt to technical requirements of connecting networks and devices. Accordingly, I agree to permit such parties to make such transmissions and changes, and hereby provide the necessary consent for the same. I certify that all of the above information is true and complete, and I understand that any falsification or omission of information may disqualify me from further consideration for employment or, if hired, may result in termination regardless of the time elapsed before discovery. Note: An offer of employment is conditioned upon complying with United Methodist Homes' requirements including, but not limited to, signing a consent to conduct a background investigation.

Signature

By entering my name and date below, I hereby authorize the use of this form as my legally binding electronic signature.

First Name

Last Name

Date

YYYY

EMPLOYMENT APPLICATION

516.699.8422

reachout@curahealth.com