Apply Now Shelbyville - Willows Healthcare

Apply Now!

Willows of Shelbyville is an equal-opportunity employer. Applicants are considered for employment without regard to race, color, national origin, religion, sex, age, disability, or any other basis prohibited by law, unless such basis constitutes a bona fide occupational qualification. Willows of Shelbyville will comply with its legal obligation to provide reasonable accommodation to qualified disabled applicants.

General Information

First name

Last Name

Street Address

City

State

Zip Code

Phone Number

Did you ever work out of the state of Indiana?

Yes No

When?

Position Sought

Department

Detailed Job Description

Please Describe

Working Hours

Full-time Part-time PRN

Working Hours

I understand that this is a full-time position

Shift(s) Preferred

Day Evening Night Any

What date would you be available for work?

Salary Desired

Do you have long-term care experience?

Yes No

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

Physical Health

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

Yes No

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

Please note that you will have to get a physical exam prior to hiring.

Are you COVID vaccinated?

Yes No

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

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.)"

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.)

Yes No

Are you 18 years of age or older?

Yes No

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)

Yes No

Have you ever had your professional licensure or certification revoked?

Yes No

Have you ever been employed by any Willows Healthcare Facility?

Yes No

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

Yes No

Education

Submit course/degree information of the highest level of education completed.

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.

License or certificate number.

Personal References

Please provide personal references that are not related to you.

First Reference

Name First Reference

Address First Reference

Phone Number First Reference

Relationship First Reference

Second Reference

Name Second Reference

Address Second Reference

Phone Number Second Reference

Relationship Second Reference

Third Reference

Name Third Reference

Address Third Reference

Phone Number Third Reference

Relationship Third Reference

Work Experience References

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

First Reference

Employer Name First Reference

Name of Contact First Reference

Their Position First Reference

Address First Work Reference

Phone Number First Work Reference

Date of Hire First Reference

Date you Left First Reference

Reason First Reference

Second Reference

Employer Name Second Reference

Name of Contact Second Reference

Their Position Second Reference

Address Second Work Reference

Phone Number Second Work Reference

Date of Hire Second Reference

Date you Left Second Reference

Reason Second Reference

Resume

Please attach your resume

Other Information

How did you hear about us?

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 of Shelbyville, personal references, and previous employers, from and all liability for any injury or damage that may result from their furnishing information to Willows of Shelbyville concerning me or any action Willows of Shelbyville 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 of Shelbyville or by me. I further understand that statements that may be contained in policies, practices, handbooks, or other Willows of Shelbyville material do not create any guarantee of employment and that Willows of Shelbyville 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 of Shelbyville, 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 of Shelbyville.

I ACCEPT THE TERMS AND CONDITIONS