Elmhurst Extended Care Center 200 E. Lake St. Elmhurst, IL 60126 Phone Number 630-516-5000 Email Address info@eeccmail.com Social Media Front Office HoursMonday09:00-05:00Tuesday09:00-05:00Wednesday09:00-05:00Thursday09:00-05:00Friday09:00-05:00Saturday09:00-05:00SundayCLOSEDDespite our office hours, we are a 24/7 facility.Work With Us General Information Date* Position Desired* Last Name*First Name*Middle Initial Email Address*Home PhoneCell Phone* Address 1*Address 2City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code* Are you a U.S. Citizen?*YesNoIf no, are you eligible to work?YesNo Availability (check all that apply)Full TimePart TimeDaysEveningsWeekendsNightsTemporarySummer How did you hear about us?*NewspaperEmployeePhone BookOtherIf other, how: Have you ever been convicted of a felony?*YesNoIf yes, please describe:Are you at least 16 years old?YesNo Have you been previously employed by Elmhurst Extended Care Center?YesNoIf yes, when:Start date:End date: Are you registered in a profession?YesNo If yes: ProfessionRegistration # StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingExp. Date EDUCATION Name of High SchoolLocation Years AttendedDid you graduate?YesNo Highest advanced education:CollegeUniversityVocationalOtherIf other, explain:Name of InstitutionLocation Did you graduate?YesNoType of degree granted?Years attended ELMHURST EXTENDED CARE CENTER (EECC) IS AN EQUAL OPPORTUNITY EMPLOYER AND DOES NOT DISCRIMINATE ON THE BASIS OF RACE, CREED, COLOR, SEXUAL ORIENTATION, AGE, NATIONAL ORIGIN, OR HANDICAP. ALL JOB APPLIANTS MAY REQUEST ANY NEEDED ACCOMMODATION OR ASSISTANCE IN ORDER TO COMPLETE THE JOB APPLICATION AND PARTICIPATE IN THE APPLICATION PROCESS. EMPLOYMENT Are you currently employed?YesNo If yes, can we contact your current employer?YesNo Present/Last Employer NamePhone NumberSupervisorDATES OF EMPLOYMENTStart DateEnd DateReason for leavingSalaryJob title and duties 2nd to Last Employer NamePhone NumberSupervisorDATES OF EMPLOYMENTStart DateEnd DateReason for leavingSalaryJob title and duties 3rd to Last Employer NamePhone NumberSupervisorDATES OF EMPLOYMENTStart DateEnd DateReason for leavingSalaryJob title and duties Job applicants are advised that the employment relationship with EECC is terminable at will. It is EECC’s policy to check references offered by applicants. It is our objective to obtain information on ability, previous job performance, character, and regulation for the sole purpose of considering you for employment. By signing this document I hereby give EECC permission to request and obtain any such information that will assist in my becoming employed. REFERENCES List professional or educational references (no friends or relatives) REFERENCE ONE NameAddressTelephoneRelationship REFERENCE TWO NameAddressTelephoneRelationship I verify that all information given on this application for employment is correct to the best of my knowledge. I understand that if any statement herein is found not to be true or if my references are not entirely satisfactory to EECC, I may be denied employment or dismissed without notice if and when discovered. I understand that employment, if offered, is for no definite period. I understand that an offer of employment and my continued employment with EECC are contingent upon satisfactory proof of my authorization to work in the United States. I agree to comply with all facility rules and regulations. I agree to complete a drug test and understand that if the results are unsatisfactory I will be terminated. I understand that a criminal background check will be completed and if any felonies are discovered, offer of employment will be revoked. If I am released for any of these reasons, I will be paid only through the day of release and my employer has the right to cancel any benefits that may have accrued.
