Employment Application Form
To take advantage of our employment opportunities please complete the form below or click on the link to access a printable form.
Please ensure form is thoroughly read and filled out. Please place N/A in the fields that do no apply.
Home Phone Number*
Cell Phone Number*
Type of School. Check All that apply*
Education Details. List particulars of your education, i.e Name of School, Years completed etc.*
Employment Experience. List last 4 Employers Address, Phone#, Time Employed/Reason for Leaving, Position etc.*
Position Applying for*
County or Counties you prefer to work*
References. Please list 2 References that are not related to you. If you have experience with adult care, one reference should relate to that experience*
Emergency Contact. Please provide name, address, relationship and phone number*
Are you a licensed driver?*
If yes, list State & License#
Have you ever been convicted of a criminal offense* (felony or misdemeanor, including DWI or DUI) other than a routine traffic violation?*
If yes, give date, nature of offense and disposition:*
I certify that the entries made by me on this form are true, complete, and accurate to the best of my knowledge, and are made in good faith and voluntarily. I understand that any false statements or answers by me may disqualify me for employment or will be sufficient grounds for termination. Moreover, I understand that failure to complete this form in its entirety will preclude me from employment at Chateau. Do you agree with the previous statement?*
*A criminal record will not necessarily prevent you from working with Chateau, but will be taking in consideration with specific positions for which you have applied.