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Name* Your Phone Number*HiddenDrivers License Number* Email* Address* Street Address Address Line 2 City State / Province ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Which Job Are You Applying For?* HiddenWhich Job Are You Applying For?*Please Choose A PositionCaregiverCertified Nursing Assistant (CNA)ChefActivities DirectorResident Care DirectorAdministratorWhich community are you applying to work at?* Brighton Manor Shelby Manor Do you have your resumé or CV handy?* Yes No Great! Upload it here:Accepted file types: jpg, doc, docx, pdf, pages, Max. file size: 50 MB.Do you want to list your work history?* Yes No Work History (Optional)Please list your work history; starting with the most recent.Business Name Business Phone NumberJob Title Contact Person Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Ending Salary Reason for leaving:May we contact this business? Yes No Business Name Business Phone NumberJob Title Contact Person Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Ending Salary Reason for leaving:May we contact this business? Yes No Business Name Business Phone NumberJob Title Contact Person Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Ending Salary Reason for leaving:May we contact this business? Yes No HiddenDesired Position at Manor Senior Living* HiddenDesired Shift* HiddenDesired Salary* HiddenDate available to start* MM slash DD slash YYYY HiddenDays & Hours available to workPlease select yes or no for each day, and please enter your availability if you select "yes". HiddenDays Available* Sunday Monday Tuesday Wednesday Thursday Friday Saturday HiddenSunday Availability HiddenMonday Availability HiddenTuesday Availability HiddenWednesday Availability HiddenThursday Availability HiddenFriday Availability HiddenSaturday Availability Have you ever been convicted of a crime?* Yes No HiddenPlease explain:*Do you want to list professional references?* Yes No Professional References (Optional)Name Relationship Phone NumberFax NumberEmail Name Relationship Phone NumberFax NumberEmail Name Relationship Phone NumberFax NumberEmail Do you want to list your education?* Yes No Education (Optional)Type of School Name of School School Location Years Completed Major / Degree Type of School Name of School School Location Years Completed Major / Degree Type of School Name of School School Location Years Completed Major / Degree How did you hear about Manor Senior Living?*Anything else you want us to know about you?
