List ALL JOBS held during the past 10 years, regardless of the location. List your MOST RECENT EMPLOYER FIRST. Explain all gaps in employment of 30 days or more. If you need more space, please use additional sheets using the same format.

Place an “checkmark” by the employer(s) you do not want us to contact

The Alliance for Aging, Inc. complies with the Americans with Disabilities Act of 1990. During the interview process, you may be asked questions concerning your ability to perform job-related essential tasks. If a conditional offer of employment is made to you, you will be required to undergo a background screening. If required, all entering employees in the same job category will be subject to the same history/physical testing requirements and all such information will be confidential and kept in secure files. The applicant agrees to such conditions as a condition of employment, insofar as such conditions are lawful and required of all persons in equivalent positions.

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application. I hereby give the Alliance for Aging, Inc. permission to contact schools, previous employers, references, regulatory and police agencies and others and hereby release the Alliance for Aging, Inc. and all entities to which it may direct such inquiries from any liabilities as a result of such contact. I understand that the hiring process will be terminated, or in the event of my employment with the Company, I shall be subject to dismissal, if any information that I have given in this application, in any resume or interview or any part of the hiring process is false or misleading or if I have failed to give any information herein requested, or if I have withheld relevant information , regardless of the time elapsed after discovery. I understand that nothing in the employment application, the granting of an interview or my subsequent employment with the Company is intended to create an employment contract between myself and the Company under which my employment could be terminated only for cause. On the contrary, I understand and agree that, if hired, my employment will be on an at-will basis and may be terminated by the Company or me at any time and for any reason. I understand that no person has any authority to enter into any agreement contrary to the foregoing.