Marquette - Application for Employment

As an applicant for employment at Marquette, it is critical that I understand and agree with the standard of service details stipulated below.

Marquette "Manners"

As an employee of Marquette, I have the power to ensure resident satisfaction.

The resident is my primary concern. While working, I will place his or her needs above my own. I will respond quickly to requests and questions and try to anticipate his or her needs.
I will treat residents, visitors, and coworkers with the utmost courtesy at all times.
I will be responsive to requests for action or information. I will not use phrases such as “That’s not my job,” “I don’t know,” or “We don’t have that.” If unsure, I will suggest that I contact someone who can help so that the issue can be resolved. I will only make such promises as I, personally, can carry out.
Furthermore, if approached by a resident or family member expressing a request or concern, I will not offer excuses such as “We’re short-staffed” or “I’m too busy”, but instead will respond positively and pleasantly.
As a representative of Marquette I will present a professional image.

My uniform or clothing will be neat, clean and in good repair.
I will wear my nametag in accordance with facility guidelines, i.e. on the upper left chest area.
If I choose to wear jewelry, it will be minimal and in good taste.
While on duty, I will not use, nor carry, nor have on my person, a cell phone, pager, portable radio, “Blue tooth” or other wireless electronic accessory, except as provided by management.

I will respect the residents, my supervisor, and my co-workers by arriving on time for my scheduled work shift and for any meetings I am asked/or required to attend.

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify the Human Resource Director.

Position applied for:	Date of Application:
First Name:	Middle:	Last:
Address:	City:	State: Zip:
Telephone:	Other Phone:	Email:

If you are under 18, will you furnish the required work permit? If NO, please explain:		YES NO
Have you ever been employed here before? If YES, give dates and positions:		YES NO
Are you legally eligible for employment in this country?		YES NO
Date available for work:	What is your desired salary range?

Type of emplyment desired: Full-time Part-time Temporary Educational Co-op
Shift Preference:
Answering "Yes" to the questions below does not constitute an automatic bar to employment. Factors such as date, seriousness/nature of the violation, rehabilitation and the position applied for will be taken into account. Traffic related violations should be included in reply below.
Have you ever been arrested for or convicted of a misdemeanor or felony? Include traffic related violations. If yes, provide dates/ details:		YES NO
Have you ever pled “Guilty” or “No Contest”, or been convicted of a crime against a dependent population? If yes, provide dates/details:		YES NO
Are there pending judgments on your nursing or aide license/certification? If yes, provide dates/details:		YES NO

EDUCATION, SKILLS and QUALIFICATIONS
Name and Location	# Years Completed	Did you Graduate?	Course of Study
High School:		YES NO
College:		YES NO
Other:		YES NO
List and summarize training, skills, licenses/certificates that may qualify you as being able to perform job related functions of the position for which you are applying:

EMPLOYMENT HISTORY
From: To:	Employer: Telephone:
Job Title:	Address:
Supervisor:	Summarize the nature of work performed and job responsibilities:
May we contact for references? Yes No Later
Hourly Rate or Salary:	Reason for Leaving:

From: To:	Employer: Telephone:
Job Title:	Address:
Supervisor:	Summarize the nature of work performed and job responsibilities:
May we contact for references? Yes No Later
Hourly Rate or Salary:	Reason for Leaving:

From: To:	Employer: Telephone:
Job Title:	Address:
Supervisor:	Summarize the nature of work performed and job responsibilities:
May we contact for references? Yes No Later
Hourly Rate or Salary:	Reason for Leaving:

REFERENCES
Name	Telephone	# Years Known

Referred By:

APPLICANT STATEMENT

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete. I understand that any false or misleading representations or omissions made on the application or during the hiring process may disqualify me from further consideration for employment and may result in discharge even if discovered at a later date.
I understand that employment may be conditioned upon successfully passing a medical examination and that I will be required to satisfactorily complete a drug screening as a condition of employment.
I hereby authorize persons, schools, my current employer (if applicable) and previous employers and other organizations to provide Marquette and its affiliates with any requested information regarding my application or suitability for employment and I completely release all such persons or entities from any and all liability related to the providing of or use of such information.
I understand that my employment is At Will which means that I may terminate the employment relationship at any time and for any reason with or without notice, and that the facility has the same right. I understand that no one has the authority to enter into any agreement contrary to the preceding sentence, except for a written agreement signed by an administrative representative of Marquette and notarized.

By checking this box I agree to all the statements above.

Signature (Full Name): Date: