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Application for Employment:

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, disability, medical condition, national origin, or marital status. 

Contact Information

Personal Information

Emergency Contact

Have you ever been convicted of a felony?


Can you be called at the last minute in case of an emergency?



Employment History

Please go back at least five years and tell us about your work history.


May we contact your current employer?

Job #1

Job #2

Job #3

Personal References

CERTIFICATION AND RELEASE: I certify that I have read and understand the application note at the beginning of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentation of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

I hereby authorize Trouvaille Memory Care to obtain information concerning my employment with my previous employers. Further, I hereby release the company or person completing this form from any and all liability in supplying the requested information.

Thank you for your submission!

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