Apply Now (Shelbyville)

1

2

3

4

5

6

7

General Information

First name *

Last name *

Street Address *

City *

State *

Zip code *

Email *

Phone *

Did you ever work out of the state of Indiana? *

YesNo

When?

2

3

4

5

6

7

Position Sought

Department *

What date would you be available for work?

Salary Desired

Do you have long-term care experience? *

YesNo

Can you describe why you think you are a good candidate for this position? *

Previous Next

1

2

3

4

5

6

7

Physical Health

Do you have a copy of your physical exam from within the last 30 days? *

YesNo

Please Upload your Physical Exam. (If you don’t have it digitally available, bring a copy to the interview.)

Upload File

Max file size 10MB.

Uploading...

fileuploaded.jpg

Upload failed. Max size for files is 10 MB.

Are you COVID vaccinated? *

YesNo

Please Upload your Vaccination Certificate. (If you don’t have it digitally available, bring a copy to the interview.)

Upload File

Max file size 10MB.

Uploading...

fileuploaded.jpg

Upload failed. Max size for files is 10 MB.

Please note that we will need to do a PPD test prior to hiring. (The PPD skin test is a method used to diagnose tuberculosis (TB) infection.) *Accept

Previous Next

1

2

3

4

5

6

7

Qualifications

Are you a U.S. Citizen or an alien legally entitled to work in the position(s) for which you have applied? (Federal law requires applicants to present certain documentation to verify their identity and United States citizen status or, if an alien, their legal authorization to work in the United States.) *

YesNo

Are you 18 years of age or older? *

YesNo

Have you been convicted of or pled guilty to a felony or have a pending case involving a felony or misdemeanor other than a minor traffic violation? (Conviction, plea, or a pending case will not necessarily disqualify the applicant from employment) *

YesNo

Have you ever been employed by any Willows Healthcare Facility? *

YesNo

Do you have any relatives that are employed by any Willows Healthcare Facility? *

YesNo

Previous Next

1

2

3

4

5

6

7

Education

Select the highest level of education

Name of School

Number of years completed.

City of School

State of School

Course(s) Pursued/Degree(s) Granted.

Previous Next

1

2

3

4

5

6

7

Personal References

Please provide personal references that are not related to you.

First Reference

Name *

Address

Phone Number *

Relationship *

Second Reference

Name *

Address

Phone Number *

Relationship *

Third Reference

Name *

Address

Phone Number *

Relationship *

Work Experience References

Please provide prior work experience. If you don’t have any, write N/A.

First Reference

Employer Name*

Name of Contact *

Their Position*

Address

Phone Number*

Date of Hire

Date You Left

Reason

Second Reference

Employer Name*

Name of Contact*

Their Position*

Address

Phone Number*

Date of Hire

Date You Left

Reason

Resume

Please attach your resume

Upload File

Max file size 10MB.

Uploading...

fileuploaded.jpg

Upload failed. Max size for files is 10 MB.

Other Information

How did you hear about us? *

Previous Next

1

2

3

4

5

6

7

Applicant's Statement

Please indicate that you have read and that you understand each paragraph of the Applicant's Statement by accepting the following terms and conditions.

I certify that this application was completed by me and that all entries on it and all information in it are TRUE and COMPLETE to the best of my knowledge. I understand that false, misleading, or omitted information in my application may disqualify me from employment or result in discharge.
I authorize the investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In making this application for employment, I understand that an investigation may be made, and information may be obtained, through interviews with the personal references and past employers listed. This inquiry may include information as to my character, general reputation, and personal characteristics, as well as information about my work performance and workplace conduct. I consent to this investigation and to the consideration of any statements of references or former employers that are given in response to the inquiry.
I hereby release all parties, including but not limited to Willows Healthcare, personal references, and previous employers, from and all liability for any injury or damage that may result from their furnishing information to Willows Healthcare concerning me or any action Willows Healthcare takes on the basis of such information.
I agree to submit to a medical examination, including drug testing, if required, and understand that any offer of employment is contingent upon the results of that examination.
I hereby authorize any doctor, hospital, clinic, laboratory, or other medical facility to furnish any medical information, with reference to me as may be necessary for the consideration of this application. I understand that this consent to release of medical records is revocable, in writing, by me at any time.
I understand that this application is not intended to be a contract of employment, and that any resulting employment relationship is for no fixed period of time and is terminable at any time and for any reason by Willows Healthcare or by me. I further understand that statements that may be contained in policies, practices, handbooks, or other Willows Healthcare material do not create any guarantee of employment and that Willows Healthcare has the right to modify, amend, or terminate policies, practices, benefits plans, or other programs within the limits and requirements imposed by law. I understand that no representative of Willows Healthcare, other than an officer, has the authority to enter into any agreement for any specific period of time or to make any agreement contrary to the foregoing and that any such agreement must be in writing to be binding on Willows Healthcare.

I ACCEPT THE TERMS AND CONDITIONS

2

3

4

5

6

7

Thank You!
You're all set.

Now that we have your application, we will review it carefully and will contact you via email if you are a good fit.

Go Back to Homepage

Apply Now in Shelbyville

General Information

Position Sought

Physical Health

Qualifications

Education

Personal References

First Reference

Second Reference

Third Reference

Work Experience References

First Reference

Second Reference

Resume

Other Information

Applicant's Statement