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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.


Email Address*

Preferred Nickname


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.

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