Menu

Page 1 of 10

  1. Platinum Living


    We appreciate your interest in the employment opportunities at Platinum Living. Our team includes professionals in Nursing (RN, LVN, CNA, RNA,) Marketing, Housekeeping, Dietary, Laundry, Maintenance, Social Services, Business Office, and Activities!

    Please inquire about current job openings. We commit to hire enthusiastic, professional and compassionate individuals who enjoy coming to work every day.

    You may use this Application for Employment form below to apply for any job.

     

    APPLICANT INFORMATION

  2. First Name / Middle Initial / Last Name*
    Please tell us your name
  3. Address*
    Invalid Input
  4. City*
    Invalid Input
  5. State*
    Please select one
  6. Zip*
    Invalid Input
  7. Phone*
    Please tell us your phone number
  8. Email*
    Please tell us your email address

  1. DESIRED EMPLOYMENT INFORMATION

  2. Date Available*
    Invalid Input
  3. Desired Salary*
    Invalid Input
  4. Position Applying For*
    Invalid Input
  5. Are You a Citizen of The United States?*
    Please select one
  6. If No, Are You Authorized to Work in The U.S.?
    Please select one
  7. Have You Ever Worked For This Company?*
    Please select one
  8. If Yes, When?
    Invalid Input
  9. Have You Ever Applied With This Company?*
    Please select one
  10. If Yes, When?
    Invalid Input
  11. Are You 18 Years or Older?*
    Please select one
  12. Have You Been Convicted of Any Crime and/or Felony in The Last Seven (7) Years?*
    Please select one
  13. If Yes, Please Explain?
    Invalid Input
  14. Desired Day(s)*



    Please select one
  15. Desired Shift(s)*



    Invalid Input
  16. If You Selected Other Above, Please Tell Us What Are Your Desired Shifts?
    Invalid Input
  17. Were You Referred by a Current Employee?*
    Invalid Input
  18. If So, Please List Employee Name
    Invalid Input
  19. Position
    Invalid Input
  20. Relationship
    Invalid Input
  21. Do You Have Any Relatives Employed by Us? *
    Invalid Input
  22. If So, Please List Employee Name
    Invalid Input
  23. Position
    Invalid Input
  24. Relationship
    Invalid Input

  1. RESUME

    (If you have a resume you would like to upload please select file and skip to the end of the form. If you do not have a resume to upload, please continue filling out the rest of this form.)

  2. Do you have a Resume to upload*
    Invalid Input
  3. Upload Resume
    Invalid Input

  1. EDUCATION

     

    High School

  2. High School Name
    Invalid Input
  3. Address
    Invalid Input
  4. Attended Highschool From
    Invalid Input
  5. Attended Highschool To
    Invalid Input
  6. Did you graduate?
    Invalid Input
  7. Degree
    Invalid Input

  8.  

    College

  9. College Name
    Invalid Input
  10. Address
    Invalid Input
  11. Attended College From
    Invalid Input
  12. Attended College To
    Invalid Input
  13. Did you graduate?
    Invalid Input
  14. Degree
    Invalid Input

  15.  

    Other Schooling

  16. Other
    Invalid Input
  17. Address
    Invalid Input
  18. Attended From
    Invalid Input
  19. Attended To
    Invalid Input
  20. Did you graduate?
    Invalid Input
  21. Degree
    Invalid Input

  1. LICENSE/CERTIFICATION

  2. Do you have a State Certification or License?
    Invalid Input
  3. If yes, what type?
    Invalid Input
  4. Issuing State
    Invalid Input
  5. Certificate or License Number
    Invalid Input
  6. Has your License/Certification ever been under review, revoked or suspended because of activity related to patient care or the performance of your duties in your profession?
    Invalid Input
  7. If yes, please explain
    Invalid Input

  1. WORK EXPERIENCE

    List below your work experience, starting with your present or last place of employment.

    EMPLOYMENT #1

  2. Date Started
    / Invalid Input
  3. Date Ended
    / Invalid Input
  4. Name of Company
    Invalid Input
  5. Address
    Invalid Input
  6. Phone
    Invalid Input
  7. Supervisor's Name
    Invalid Input
  8. Job Title
    Invalid Input
  9. Salary
    Invalid Input
  10. Reason for Leaving
    Invalid Input
  11. May we contact your previous supervisor for a reference?
    Invalid Input

  12.  

    EMPLOYMENT #2

  13. Date Started
    / Invalid Input
  14. Date Ended
    / Invalid Input
  15. Name of Company
    Invalid Input
  16. Address
    Invalid Input
  17. Phone
    Invalid Input
  18. Supervisor's Name
    Invalid Input
  19. Job Title
    Invalid Input
  20. Salary
    Invalid Input
  21. Reasons for Leaving
    Invalid Input
  22. May we contact your previous supervisor for a reference?
    Invalid Input

  23.  

    EMPLOYMENT #3

  24. Date Started
    / Invalid Input
  25. Date Ended
    / Invalid Input
  26. Name of Company
    Invalid Input
  27. Address
    Invalid Input
  28. Phone
    Invalid Input
  29. Supervisor's Name
    Invalid Input
  30. Job Title
    Invalid Input
  31. Salary
    Invalid Input
  32. Reasons for Leaving
    Invalid Input
  33. May we contact your previous supervisor for a reference?
    Invalid Input

  1. MILITARY SERVICE

  2. Branch
    Invalid Input
  3. Attended From
    / Invalid Input
  4. Attended To
    / Invalid Input
  5. Rank at Discharge
    Invalid Input
  6. Type of Discharge
    Invalid Input
  7. If other than honorable, explain:
    Invalid Input

  1. SPECIALIZED TRAINING / SKILLS / ORGANIZATIONS

  2. Please list any specialized training or skills you have that you consider relevant to the job in which you are applying for. You may also list any professional groups or organizations you belong to.
    Invalid Input

  1. REFERENCES

    List below three people not related to you.

    REFERENCE #1

  2. Full Name
    Invalid Input
  3. Relationship
    Invalid Input
  4. Company Name
    Invalid Input
  5. Phone
    Invalid Input
  6. Address
    Invalid Input

  7.  

    REFERENCE #2

  8. Full Name
    Invalid Input
  9. Relationship
    Invalid Input
  10. Company Name
    Invalid Input
  11. Phone
    Invalid Input
  12. Address
    Invalid Input

  13.  

    REFERENCE #3

  14. Full Name
    Invalid Input
  15. Relationship
    Invalid Input
  16. Company Name
    Invalid Input
  17. Phone
    Invalid Input
  18. Address
    Invalid Input

  1. Disclaimer and Electronic Signature

    I Understand:

    • That completing this application does not constitute an offer of employment and that my application may be rejected for any reason.
    • That giving false or misleading information on this form or in an interview is grounds for denial or immediate termination of employment.
    • That I may be required to complete a medical history form and may be required to be examined by a medical professional designated by Platinum Living.
    • That if I sustain any injury or illness in the employment of Platinum Living, I agree that Platinum Living shall be entitled to receive full and complete reports and records covering any medical or related exams, and I authorize any and all such doctors, medical examiners, and hospitals to give to Platinum Living full and complete reports and records covering such examinations, condition, care, and treatment related to or resulting from the alleged illness or injury.

     

    Authorization to Release Information:

    If I am given a conditional offer of employment, I authorize Platinum Living to make a complete investigation of me, including but not limited to: my past employment history, medical history, scholastic records, criminal records, abuse records, motor vehicle driving records, workers’ compensation history and to rely on such information sources. I authorize all persons and organizations to release any information concerning my background and hereby release all persons and organizations from liability for any damage whatsoever for issuing this information. I acknowledge that a telephone facsimile (fax) or photographic copy shall be as valid as the original.

    By checking below, I certify that I have not been convicted of an offense that would preclude working in a nursing facility. I also certify that I am not excluded from participation in federal health care programs. Furthermore, I understand that I will be subject to a search of the OIG List of Excluded Individuals, and that a comprehensive criminal background screening will be completed by a third party organization acting on behalf of Platinum Living. If the findings of that background screening result in a refusal to hire, I will be notified in writing and may request a copy of the findings from the third party organization.

    I understand that the use of illegal drugs is prohibited during employment. If employment policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and/or during employment.

    I understand that this employment application and any other employee-related documents are not contracts of employment; and that any individual who is hired may voluntarily leave employment upon proper notice, and may be terminated by the employer at any time for any reason. I understand that any oral or written statements to the contrary are hereby expressly disavowed and should not be relied upon by any prospective or existing employee.

    I certify that my answers are true and complete to the best of my knowledge.

    If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

  2. Please Read and Approve The Information Above by Checking Below*
    Please authorize that you have read and approve the information above.
  4. Enter The Code*
    Enter The Code RefreshYou have entered a wrong verification code!