Application for Employment

We would love for you to come join our Friends Team at any of our 12 Village locations or with our Entrusted Hearts team, which provides home health services and medical equipment to clients across the state of Oklahoma. Please fill out the application below to begin the process of working with us. If you have any questions please contact us.

Step 1 of 7 - Personal Information

References
(do not include relatives or former employers)
Name and Occupation*
Address*
Phone Number*
Name and Occupation*
Address*
Phone Number*
Name and Occupation*
Address*
Phone Number*

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Education and Training
Name of High School*
Location*
Grade Completed*
Year and Degree*
Name of College
Location
Year Completed
Year and Degree
Other Education/Training
Location
Grade/Year Completed
Year and Degree

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Employment and Record
(list last or present position first) If any breaks or gaps in employment exist, please briefly explain below.
Employer 1*
Address*
Street Address City State ZIP Code
Supervisor
Phone*
Date Employed From*
Date Employed To*
Starting Salary Range*
Ending Salary Range*
Position and Duties*
Employer 2
Address
Street Address City State ZIP Code
Supervisor
Phone
Date Employed From
Date Employed To
Starting Salary Range
Ending Salary Range
Position and Duties
Employer 3
Address
Street Address City State ZIP Code
Supervisor
Phone
Date Employed From
Date Employed To
Starting Salary Range
Ending Salary Range
Position and Duties
Employer 4
Address
Street Address City State ZIP Code
Supervisor
Phone
Date Employed From
Date Employed To
Starting Salary Range
Ending Salary Range
Position and Duties
Employer 5
Address
Street Address City State ZIP Code
Supervisor
Phone
Date Employed From
Date Employed To
Starting Salary Range
Ending Salary Range
Position and Duties
If your former employment references, education or military service are under a name other than indicated on front of application, please indicate:*
(If not applicable, put N/A)
May we contact your present employer at this time?*
- Yes
- No
Have you ever been convicted of a crime?*
- Yes
- No
Conviction of a criminal offense will not necessarily preclude your employment.
If yes, for what, when and where?*

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Professional Licenses and/or Certification
Type
Organization or State
Date Issued
Number
Verification
Type
Organization or State
Date Issued
Number
Verification
Type
Organization or State
Date Issued
Number
Verification

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Office Skills
Please list all computer/software programs you are experienced in*
Example: Word, Excel, Outlook, PowerPoint, Publisher, Access, etc...
Typing speed wpm*
Writing/Editing*
- Fair
- Good
- Excellent
Office Equipment
(If not applicable, put N/A)
Why are you applying for a position in this ministry with senior adults?*

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Employment Acknowledgment
(please read and sign)
Baptist Village Communities does not discriminate in its hiring decisions or in any other employment decision on the basis of race, color, sex, citizenship, national origin, veteran status, age or upon a physical or mental disability which is unrelated to the applicant’s/employee’s ability to perform the essential functions of the position.

As part of the application process, I voluntarily give Baptist Village Communities the right to make a thorough investigation of my past employment background and activities. I further agree to cooperate fully in such investigation. I hereby release from all liability and responsibility any and all persons, companies or entities which provide Baptist Village Communities with information or documents requested by Baptist Village Communities as part of the application process.

If I am hired by the company, I understand that my employment will be "at will," meaning either party - me or the company - will be able to terminate my employment at any time, with or without cause. I also understand that my employment may be terminated for any misstatement of fact appearing on, or omission of fact from, this application form.

Further, I understand that after I am given a conditional offer of employment, I may be required to undergo a physical examination as well as a background check screening as a prerequisite to my continued employment with the company. I hereby consent to take that physical examination and any such future physical examinations as are required by the company.

Finally, I understand that I, like every other employee of this company, will be required to complete an Employment Verification Form (I-9) within three (3) days of my employment. At that time, I will produce the documentation of my choosing which will satisfy the requirements stated on the I-9 form for proof of identity and eligibility for employment.
Signature*
First Middle Last
Employment Acknowledgement Date*

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Application for Employment

Step 1 of 7 - Personal Information

Personal Information

References

Education and Training

Employment and Record

Professional Licenses and/or Certification

Office Skills

Employment Acknowledgment

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