Day Share Application for Employment

We Are An Equal Opportunity Employer.

I certify that answers given herein are true and complete to the best of my knowledge. I authorize you to make such investigations and inquires of my personal, employment, financial or medical history and other related matters as my be necessary in arriving at an employment decision. I hereby release employers, schools or persons from all liability in responding to inquiries in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also, that I am required to abide by all rules and regulations of Day Share Senior Services.

Position applying for
Do you have reliable transportation
Are you a citizen of the United States
If you are not a citizen of this country what is your status
Summarize special skills and qualifications
Do you have a criminal record
Who may we contact in the event of an emergency