Abbore Care Incorporated is accredited by the Joint Commission for Accreditation of Healthcare Organizations (JCAHO).


Our Locations: Toledo (OH) | Cincinnati (OH) | Southfield (MI)

Programs

KEVDACO HUMAN SERVICES, LLC
TBI & SPINAL CORD
Application for Employment
All prospective employees will be considered without discrimination because of Race, color, sex, natural origin, or handicap. All information here will be kept confidential. A pre employment TB TEST and POLICE CLEARANCE are required by all applicants offered a job at Kevdaco Assisted Living, Inc.
PERSONAL
Last Name:
First Name:
Middle Name:
Street Address:
City:
State:
Zip:
Home Phone: Business Phone:
Emergency Contact (not living with you) Phone:
Have you ever applied for employment with Kevdaco Assisted Living, LLC?
Yes
No:
If yes, Month, Year:
How many hours a week are you available for work?
Min. Hrs:
Max. Hrs:
When will you be available for work? (date):
Are you legally eligible for employment in the United States?
Yes
No
How did you learn of our organization?:
Are you willing to Work?
Position applying for:
Note: The office will call you for your SSN and Date of Birth.
EDUCATION
  College
School Name:
Location:
Course:
Years:
Degree:
  Vo-Tech or Trade
School Name:
Location:
Course:
Years:
Degree:
  High School
School Name:
Location:
Course:
Years:
Degree:
EMPLOYMENT
List the last 10 years of your employment history, starting with the most recent employer
1
 Company Name:
  Address:
  Name of Supervisor:
Telephone:
  Dates of Employment:
From:
To:
  Starting Pay:
Ending Pay:
  Job Title and describe work:
  Reason for leaving:
2
 Company Name:
  Address:
  Name of Supervisor:
Telephone:
  Dates of Employment
From:
To:
 
Starting Pay:
Ending Pay:
  Job Title and describe work:
  Reason for leaving:
3
 Company Name:
  Address:
  Name of Supervisor: Telephone:
  Dates of Employment From: To:
  Starting Pay:
Ending Pay:
  Job Title and describe work:
  Reason for leaving:
Was your last name different from your present one during the above listed jobs?
If yes, what was your name?
Are you currently employed?
May we contact your present employer?
Do you have reliable transportation if required?
PROFESSIONAL REFERENCES
Person who can furnish information about job performance
1
 Name:
Address:
Telephone #:
2
 Name:
Address:
Telephone #:
3
 Name:
Address:
Telephone #:
GENERAL
Have you ever been convicted of a crime in the past ten years, excluding misdemeanors and summary offences, which have not been annulled, expunged or sealed by a court?
If yes describe in full: (Conviction will not neccessrily disqualify an applicant from employment
Are capable of performing the job duties set forth in the job description?
If you answered No, which job requirements can you not meet?
CREDENTIAL / SPECIALIZED SKILLS & QUALIFICATIONS OPERATED
List all states in which licensed giving registration and expiration date. Summarize special job related Skills and qualifications acquired from employment or other experience.
I certify that the facts contained in this application are true and comlete to the best of my knowlege and understand that, if employed; falsified statements on this application SHALL BE GROUNDS FOR DISMISSAL.
I authorize complete investigation of all statments contained herein and hereby give my full permission for Abbore Healthcare Service Inc. any and all information concerning my previous employment and any information they may have, and result from furnishing same to Abbore Healthcare Service.
I understand and agree that if hired, my employment is not definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time for lawful reason, without prior notice and with or without cause.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period shall inquire as to whether or not applications are being accepted at that time.
 
Date: Signature (Please print name)

 

 

Contact Us

Office: 23999 Northwestern Hwy, Suite 200, Southfield, MI 48075
Telephone: (248) 569-1040 Toll-free: (800) 478-7186
Fax: (248) 569-1310
Email: abborehealthcare@gmail.com