Employment Application

This application is intended for use by Metro Health Foundation of NH, Inc. d/b/a Golden View Health Care Center. Golden View Health Care Center includes The Inn at Golden View, The Terrace, The Cottage and The Retreat at Golden View. Metro Health Foundation of NH Inc.’s policy prohibits discrimination on the basis of age, race, color, religion, sex, marital status, sexual orientation, service in the armed forces of the United States, national origin, citizenship, disability, or any other protected classification.

NOTICE TO APPLICANTS AND EMPLOYEES

Screening tests for illegal drug use may be required before hiring and during your employment here. 

PLEASE PRINT CLEARLY AND COMPLETE ALL INFORMATIONREQUESTED.

NAME AND ADDRESS
ADDITIONAL INFORMATION



List any friends or relatives working for us:



POSITION DESIRED

What are the two (2) most important factors to you in this position?

WORK SCHEDULE

What is the minimum # of hours you could consider acceptable?




What days & times are you available to work? Include a.m. or p.m.:


EMPLOYMENT STATUS



EMPLOYMENT HISTORY
EMPLOYMENT RECORD

List most recent or present employer first. Include military service (not country of service), or any self-employed or unemployed periods. You must account for the past three (3) employers or past five (5) years or since completing school, whichever is more recent.

PRESENT OR MOST RECENT EMPLOYER
EMPLOYER 1
EMPLOYER 2
EDUCATION
IF YOU ATTENDED HIGH SCHOOL
IF YOU ATTENDED COLLEGE


EDUCATION AND TRAINING
LICENSES
EMPLOYMENT

If hired, verification will be required consistent with Federal Law.

REFERENCES

Give the names of 2 persons who are not relatives or former employers, who have known you for five (5) years or more

REFERRAL INFORMATION
IN CASE OF EMERGENCY, NOTIFY:
CONDITIONS OF EMPLOYMENT

Golden View Health Care Center sets high standards for its associates. We require compliance with the standards as a condition of employment. You need to carefully consider what will be required before accepting a position with us. As an employee, you would be expected to comply in full. You need to know and understand what Golden View will require of you if you are hired.

Customer Service:

  • Totally believe in and support our customer first approach to business.
  • Be friendly to our customers.
  • Do everything you can make our customers feel welcome in our facility, including: smiling, greeting the customer promptly, being helpful, using the customer's name, saying "thank you"
  • Demonstrate our Values: Respect, Responsibility, Honesty, Fairness and Compassion

Job Expectations:

  • Work hours as scheduled -- report to work on time.
  • Take direction from supervisors and execute directions to the best of your ability.
  • Maintain a positive, enthusiastic attitude at all times, and be a cooperative member of the Golden View team.
  • Perform job as described in Job Description

Personal Appearance:

  • Follow dress code for your position.
  • Wear your Golden View name badge at all times.


LANGUAGE TO COVER MANDATES OF NURSING FACILITY REGULATIONS AS IT PERTAINS TO PATIENT ABUSE AND HEALTH FACILITY LICENSING

1. Have you ever been convicted and/or found guilty by a court of competent jurisdiction or a state agency of abuse, neglect, fraud, assault or exploitation of any person in this state or any other state? If so, please describe the offense, the date and place of convicting and the underlying circumstances or other information to help us evaluate your current fitness for employment.

2. Have you ever been convicted of: (1) a felony or misdemeanor that has not been nullified; (2) sexual assault, other violent crime, assault, fraud, abuse, neglect, or exploitation of any person in this state or any other state; (3) assault of a victim sixty years of age or older? If "YES", please describe the offense, the date and the underlying circumstances or other information to help us evaluate your current fitness for employment.

3. Have you ever been subject to disciplinary action by a health care licensing agency in this or any other state, or in any other United States or foreign jurisdiction? If "YES", please identify the nature and date of the action, the licensing agency involved, and the underlying circumstances or other information to help us evaluate your current fitness for employment.

I hereby certify that I have not been convicted and/or been found guilty of assault, fraud, abuse, neglect, or exploitation of any person in this state or any other states, and that I am not listed in any resident or patient abuse registry in this state or in any other state. I understand that any offer of employment that is extended to me by Golden View Health Care Center is conditional upon the verification of this information with the state patient abuse registry, and that a listing in such registry or the registry of any other state or perpetration of an act that would result in a listing in the abuse registry may act as an automatic withdrawal of such offer of employment by Golden View Health Care Center.

I further understand that any offer of employment by Golden View Health Care Center is conditional upon verification of state licensure as applicable.

EMPLOYEE RELEASE

I understand and agree that any offer of employment will be contingent upon successful completion of a post job offer physical examination, medical clearance and a negative drug screen establishing that I am capable of performing the essential functions of the job for which I have applied, with or without reasonable accommodation.

I certify that the statements I have made in this application are true, and I hereby grant Metro Health Foundation of NH Inc. d/b/a Golden View Health Care Center permission to verify the accuracy and completeness of this information, contact all or any of my previous or current employers and references and to investigate all educational and criminal records.

I understand and agree that if my application is accepted, my employment may be terminated by me or Golden View Health Care Center at any time, with or without cause. I further understand that, if accepted, my employment is for no definite period and may be terminated without notice. I understand that any representation made by Golden View Health Care Center in connection with my application for employment must be made by an authorized officer of Golden View Health Care Center and in writing.

SUPPLEMENTAL EMPLOYMENT APPLICATION INFORMATION

The Golden View Community is committed to hiring those individuals whose personal values will align with our organizational culture. At Golden View, we believe that every employee must possess five key values: RESPONSIBILITY, RESPECT, FAIRNESS, COMPASSION, & HONESTY.