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about us
Stories From Home
Share Your Story
Meet Our Team
History & Affiliations
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Tool Thrift Shop
Pandemic Emergency Plan
services
Independent Living
NOW OPEN – The Woodlands
Senior Options for Independence
Housing
Assisted Living / Skilled Nursing
Assisted Living
Skilled Nursing Care
Rehabilitation
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Our Culture
Pastoral Care
Amenities
Dining Experience
Activities
Recreation & Activity Calendars
giving
Ways to Give
Making a Gift
Foundation Board of Directors
Foundation News
Publications
Corporate Associates 2017
Fundraiser Events
Step Up For Seniors Walk
Swing for Seniors
Volunteering
The Service Board of FBH
Allocations Committee
admissions
newsworthy
employment
contact
request information packet
about us
Stories From Home
Share Your Story
Meet Our Team
History & Affiliations
Board of Directors
Tool Thrift Shop
Pandemic Emergency Plan
services
Independent Living
NOW OPEN – The Woodlands
Senior Options for Independence
Housing
Assisted Living / Skilled Nursing
Assisted Living
Skilled Nursing Care
Rehabilitation
lifestyle
Our Culture
Pastoral Care
Amenities
Dining Experience
Activities
Recreation & Activity Calendars
giving
Ways to Give
Making a Gift
Foundation Board of Directors
Foundation News
Publications
Corporate Associates 2017
Fundraiser Events
Step Up For Seniors Walk
Swing for Seniors
Volunteering
The Service Board of FBH
Allocations Committee
admissions
newsworthy
employment
contact
request information packet
employment application
Contact Information
Fairport Baptist Homes is an equal opportunity employer and does not discriminate because of race, creed, color, national origin, religion, age, sex, disability, sexual orientation, marital status, military status, genetic predisposition or carrier status, or any other status protected by law. No questions on this application are asked for the purpose of limiting or excluding any applicant’s consideration for employment. Fairport Baptist Homes hires qualified individuals regardless of disability and will reasonably accommodate an individual’s disability during the application process and on the job. Such employees are encouraged to request a reasonable accommodation when necessary.
Name
*
First
Middle
Last
Application Date
*
Date Format: MM slash DD slash YYYY
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone Numbers
If you need additional rows, please click the + below.
Select a Type
Please enter your phone number
Home
Work
Cell
Email
*
Have you ever worked for the Homes under a different name?
*
Is additional information relative to change of name, use of an assumed name or nickname necessary to enable check on your work records?
Yes
No
Explain...
*
Position or type of work desired:
I am available to work:
*
Full Time
Part Time
Per Diem
Shift Preference
I can work weekends
I can work on holidays
Are you 18 years of age or older?
*
Yes
No
Have you previously applied to Fairport Baptist Homes?
*
Yes
No
If yes, what position?
When would you be available to start?
Please list any relatives/friends that work at Fairport Baptist Homes
Education
Schools Attended
If you need additional rows, please click the + below.
Please provide a list of schools or universities attended.
School
Name and Address of School
Last Year Attended
Diploma Degree
Course of Study
Elementary
High School
College
Other Special Training
School of Nursing
Nursing/Professional License/Certification No. and Type
If you need additional rows, please click the + below.
* If you cannot provide your CNA Certification number with your application, you will be asked to supply it during our follow-up interview / conversation.
License Name
Date
CNA Certification # *
Have you ever been found guilty of unprofessional misconduct, or negligence in any profession?
*
Yes
No
Are charges now pending against you for unprofessional conduct, professional misconduct, or negligence in any profession?
*
Yes
No
Have you ever surrendered any license in lieu of disciplinary procedure?
*
Yes
No
If “Yes” answered to any of the above three questions, please explain.
Are you legally entitled to work in the U. S.?
*
Yes
No
Have you ever been convicted of a crime (other than traffic violation)?
*
Yes
No
If yes, please explain:
Note: Prior criminal conviction is not necessarily a bar to employment.
Were you previously employed by any program of Fairport Baptist Homes?
*
Yes
No
If yes, please give dates:
Have you ever worked at FBH through an agency or temporary agency?
*
Yes
No
Employment Experience
Please list all previous employers for the last 10 years.
If you need additional rows, please click the + below.
Starting with your current employer, please provide each field with information as requested below.
Employer Name
Address
Phone
Dates (MM/YY)
Base Pay Rate?
Paid How Often?
Reason for Leaving
Your Title
Description of Responsibilities
Professional References
Please provide employment contacts and references
If you need additional rows, please click the + below.
(Please do not list friends or family members)
Name
Address / Phone
Number of Years Known
Nature of Relationship
I authorize Fairport Baptist Homes to verify the accuracy of information provided on this application and to obtain reference information on my work performance. I hereby release Fairport Baptist Homes, and any party supplying references, from any liability for an employment decision based on such information.
With regard to my current employer, Fairport Baptist Homes:
*
may contact my current employer.contact my current employer.
may NOT contact my current employer.
Authorization for the Fairport Baptist Homes, to review any and all records pertaining to my background and criminal history
*
I agree and give my permission.
I do NOT agree and do NOT give my permission.
Without permission to review your background, we can not submit this application.
Signature
*
Please sign below by typing your full legal name followed by the date in the following format: Name - MM.DD.YYYY
Email
This field is for validation purposes and should be left unchanged.