Application for Employment   * Required * Name (Last, first): Present Address: City: State: Zip: Permanent Address: City: State: Zip: * Daytime phone: Alternate phone: Email address: Referred by, if applicable: I would like to apply to the following locations (select all that apply): Assisted Living Communities Independent Senior Living Communities Appledorn, Holland, MI Bay Ridge, Traverse City, MI Edgewood, Saginaw, MI Grand Pines, Grand Haven, MI Railside, Bryon Center, MI Seminole Shores, Muskegon, MI Sheldon Meadows, Hudsonville, MI The Village at Appledorn, Holland, MI The Village at Bay Ridge, Traverse City, MI The Village at Park Terrace, Muskegon, MI The Village at the Pines, Grand Haven, MI Waverly Meadows, Holland, MI The Village at Arborwood, Granger, IN I would like to apply for the following positions (select all that apply): Assisted Living Communities Independent Living Communities Administrator Office Manager Resource Manager Community Relations Receptionist Resident Services Coordinator – LPN Manager Resident Support Staff Shift Supervisor Medications Tech Life Enrichment Coordinator Life Enrichment Assistant Records Specialist Chef – Director of Culinary Services Cook Kitchen Utility Worker/Dishwasher Housekeeping & Laundry Supervisor Housekeeper & Laundry Assistant Maintenance Supervisor Maintenance Assistant Resident Porter Community Manager Administrative Assistant Social Activities Director Social Activities Assistant Cook Kitchen Utility Aide Dining Service Housekeeping Supervisor Housekeeper Maintenance Supervisor Maintenance Assistant Date you are available to start work: Salary desired: $ Are you currently employed?: Yes No Do you have reliable transportation to get to work?: Yes No Are you interested in (check all that apply): Full-Time: Yes No Part-Time: Yes No On-Call: Yes No Are you available to work (check all that apply): Days: Yes No Nights: Yes No Weekends: Yes No Have you ever applied to this company before?: Yes No If yes, where: When: UPLOAD RESUME If applicable, please attach your resume below If resume is provided, you may skip the remaining fields and scroll to the bottom of the form and click the SUBMIT button. EDUCATION HISTORY What is the highest level of education you have achieved? Still Attending High School High School Degree GED Certificate Bachelor Degree Masters Degree Doctorate CERTIFICATIONS Do you have any of the following certifications: CNA MA LPN EMT Other Other PREVIOUS EMPLOYMENT   From date To date Name and address of employer Salary Position Reason for leaving 1. 2. 3. Please use this area to tell us about yourself and any special skills or training you may have: