EMPLOYMENT

Whether you are looking for your first entry-level position or seeking to further the development of your professional career, Bell Tower Residence may be an excellent choice for you.

 

At Bell Tower Residence, we promote high standards in our care for the older adult along with a strong sense of commitment and dedication. We are looking for individuals who enjoy interacting with our seniors and want to work at a ministry that lives the values of community, compassion, respect and excellence.

 

We offer rewarding work opportunities with a competitive wage and benefit package along with continued education and a positive working environment. Bell Tower Residence is an equal opportunity employer. We recognize staff members for a job well done through various events such as our annual employee appreciation dinner or our summer family picnic.

 

If you are interested in joining the Bell Tower Residence team, contact us.

 

 

EMPLOYMENT APPLICATION 

DO NOT WRITE IN THIS SPACE

Department                                                        ­        Position Title                                                                 ­

 

Employment Classification :           ­ Full-Time            ­ Part – Time             ­ Occ.                ­Temp.

 

Starting Date                                                     ­        Supervisor                                                                    ­

 

Hourly Rate                             ­         Hours Per Pay Period                                   ­  F.T.E.                          ­

 

Shift worked  ________________                        

 

Acceptance Date                                      ­   I9 Completed                           ­  Date of Birth                          ­

 

Who Can We Contact in Case of Emergency:

1)                                                                           ­   Telephone # ­­­­­­­­­­­­­­­­­­­­­­­                                                                    ­

 

2)                                                                           ­   Telephone # ­­­­­­­­­­­­­­­­­­­­­­­                                                                    ­

 

Interviewed By:                                                               ­  Date Interviewed                                                 ­

 

Check References:           ­ Yes           ­ No     Date Referenced                              ­  By                                 ­

 

Remarks:

 

APPLICATION FOR EMPLOYMENT

 

PLEASE PRINT                                                      DATE                              ­                         1500 O’Day St

                                                                                                                                                 Merrill WI  54452

PERSONAL:                                                                                                                             715-536-5575

Name (First, Middle, Last)

 

 

 

Are You Under 18?     Yes          ­  No           ­

 

If Yes, Date of Birth                                        ­

Address (Street, City, State, Zip)

Social Security Number

 

 

Telephone Number

 

(        )

Telephone Number(s) Where We Can Reach You During the Day

 

 

 

How Did You Learn Of Bell Tower Residence?   (Be Specific)

 

 

 

GENERAL:

Position(s) Applied For

Date Available For Work

 

 

 

Applying For

______ Full-Time    _____ Occasional

 

______ Part-Time    _____ Temporary

What Shift(s) Will You Work?

_____ Days   _____ Nights ____ Weekends

 

_____ PMs  _____ Rotating ____ Holidays

Wage or Salary Requirements

 

SKILLS:

All Applicants – Please list any experiences, skills and qualifications which may relate to the job you are applying for                          (excluding the information listed on the following page and any reference to religious, ethnic or racial affiliations).

 

 

 

 

 

 

ALL CURRENT PROFESSIONAL LICENSES, ACCREDITATIONS AND/OR CERTIFICATIONS:

     Full Title: (Initials) – Number                               Issued By This Authority                    Expiration Date

Example:Registered Nurse(RN)- #0000

State of Wisconsin 10/01

 

 

EDUCATION

 

 

YEARS ATTENDED

CIRCLE LAST YEAR COMPLETED

DID YOU GRADUATE?

LIST DIPLOMA, DEGREE OR COURSE OF STUDY

High

From

To

 

1    2    3   4

______ Yes

 

______  No

 

Business/Technical

From

To

 

1    2    3   4

______ Yes

 

______  No

 

NursingFrom

To

 

1    2    3   4

______ Yes

 

______  No

____LPN     ____RN

____ADN    ____BSN

____Diploma

College

From

To

 

1    2    3   4

______ Yes

 

______  No

 

Other (Specify)

From

To

 

1    2    3   4

______ Yes

 

______  No

 

Please List Any Academic Honors You Have Received

 

 

WORK HISTORY:

 

 

PRESENT OR LAST EMPLOYER

 

 

NEXT PREVIOUS EMPLOYER

 

 

NEXT PREVIOUS EMPLOYER

 Company Name

Employed

           From                             To

Address                                     City          State          Zip

 

 

Telephone

Type of Work

Last Salary

 

        Full-Time              Part-Time

Name of Supervisor

 

 

Reason for Leaving

May We Contact?

Company Name

 

Employed

           From                             To

Address                                     City          State          Zip

 

 

Telephone

Type of Work

Last Salary

 

        Full-Time              Part-Time

Name of Supervisor

 

 

Reason for Leaving

May We Contact?

Company Name

 

Employed

           From                             To

Address                                     City          State          Zip

 

 

Telephone

Type of Work

 

 

Last Salary

 

        Full-Time              Part-Time

Name of Supervisor

 

 

Reason for Leaving

May We Contact?

References – please provide two or three professional references (no personal references please):

 

 

  Reference                                        Relationship                           Phone Number

 

 

 

 

 

 

 

AGREEMENT

READ CAREFULLY AND ACKNOWLEDGE BY YOUR WRITTEN SIGNATURE AND TODAY’S DATE

 

I certify that the facts set forth in this application are true and complete.  I authorize investigation of the statements I have made herein.

 

I hereby release from any and all liability all representatives of the Bell Tower Residence for their acts performed in good faith and without malice in connection with evaluating my application, credentials and qualifications.  I hereby further authorize any party having information bearing upon my qualifications for employment to release such information to Bell Tower Residence (unless otherwise stated).  I also release from any and all liability all individuals and organizations who provide information to Bell Tower Residence in good faith and without malice concerning my employment competence, ethics, character and other qualifications, including other privileged or confidential information.

 

I understand that any false statements on this application shall be sufficient cause for denial of employment or summary dismissal.   I also understand that my employment at Bell Tower Residence is contingent upon the satisfactory completion of a physical examination and investigation of my work record and references.  I consent to a pre-employment physical examination and such future examinations as may be required by Bell Tower Residence.  I further understand that, if employed, I will serve a three-month probationary period from my date of employment and that this employment agreement is not binding for either party for any specific period of time.

 

Signature of Applicant                                                                     Date

 

RELEASE OF INFORMATION

I hereby authorize Bell Tower Residence to obtain information from my schools/employers for the purpose of determining employment.

 

 

 

­­­­­­­­­­­­­­­­­­                                                                        ­                                                                                                ­

Signature of Applicant                                                                     Date

 

**If your education, employment or military records are under a name other than the name above, please indicate below:

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1500 O’DAY STREET • MERRILL, WI 54452-3497 • PHONE: 715-536-5575 • CONTACT

Bell Tower Residence Assisted Living accepts private pay and long term care insurance.

©2019 Bell Tower Residence: Merrill, WI - All Rights Reserved