Applicant Information

First Name *

Last Name *

Phone Number *

Email *

Address

Street Address *

City

State

Postal code

Employment Position

Position applying for: Bathing Assistant.

How did you hear about this position?

What days are you available for work

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

How many hours a week are you available (min. 6)? *

If needed are you available to work overtime?

Yes

On what date can you start working if hired? *

Do you have reliable transportation, to and from work?

Yes

Personal Information

Have you ever applied to or worked for Simply Bathing before? *

Yes

When did you apply?

Do you have any friends, relatives, or acquaintances working for Simply Bathing? *

Yes

What is their name and relationships with you?

Are you 18 years of age or older? *

Yes

Are you a U.S. citizen or approved to work in the United States? *

Yes

What document can you provide as proof of citizenship or legal status?

Will you consent to a mandatory controlled substance test? *

Yes

Do you have any condition which would require job accommodations? *

Yes

Please describe accommodations required below.

Have you ever been convicted of a criminal offense (felony or misdemeanor)? *

Yes

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:

Job Skills/Qualifications

Please list below the skills and qualifications you possess for the position for which you are applying: *

(Note: Simply Bathing complies with the ADA and considers reasonable accommodation

measures that may be necessary for eligible applicants/employees to perform essential

functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional. )

Education and Training

High School *

Name
City
State
Year Graduated
Degree Earned

College

Name
City
State
Year Graduated
Degree Earned

Vocational School / Specialized Training

Name
City
State
Year Graduated
Degree Earned

Are you a member of the Armed Services? *

Yes

What branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

Previous Employment

Employer 1

Company Name
Job Title
Supervisor Name
Employer Address:
Employer Phone
Dates Employed
Reason for Leaving

Employer 2

Company Name
Job Title
Supervisor Name
Employer Address
Employer Phone
Dates Employed
Reason for Leaving

References

Reference 1

Name
Email
Phone

Reference 2

Name
Email
Phone

At-Will Employment

The relationship between you and the Simply Bathing is referred to as "employment at

will." This means that your employment can be terminated at any time for any reason,

with or without cause, with or without notice, by you or the Simply Bathing. No

representative of Simply Bathing has authority to enter into any agreement contrary to

the foregoing "employment at will" relationship. You understand that your employment

is "at will," and that you acknowledge that no oral or written statements or

representations regarding your employment can alter your at-will employment status,

except for a written statement signed by you and either our Executive Vice-President/

Chief Operations OfÏcer or the Company's President.

Applicant Signature *

Clear

Today's Date *

I would like to receive SMS text messages from Simply Bathing regarding my application. By providing my phone number, I agree to receive text messages from Simply Bathing (Message and Data rates may apply).