Online Application

Step 1: Personnel Info

Full Name:
Email:
Address:
City:
State | ZIP:
Phone:
If you cannot be reached at the above number, where can we contact you?

Step 2: Employment Desired

Type of work desired:
Shift:
Will you accept employment?
Full time?
Part time?
Are you employed now?
Yes
No
May we contact your present employer?
Yes
No
If no, why?
Have you ever worked at The Forest at Duke?
Yes
No
Are you 18 years of age or older?
Yes
No
How did you learn of this opening?

Step 3: Education

  School Location Courses taken Degree/Certificate
Grammar/grade school
High school
College
Vocational
Professional
Graduate school
Scholastic honors received:
Extracurricular activities in school:
Member of professional organizations:
Were you in the armed forces?
Yes
No
If yes, what branch?
Beginning and ending dates of duty:
to
Rank at discharge:

Step 4: Professional Licenses and/or Certificates

Type Organization Date Number Verification

Step 5: Employment Recors (List most recent/present position first)

Employer:
Address:
Supervisor:
Phone:
Start date:
End date:
May we contact this employer?
Yes
No
Salary range:
Position/duties:
Reason for leaving:
Employer:
Address:
Supervisor:
Phone:
Start date:
End date:
May we contact this employer?
Yes
No
Salary range:
Position/duties:
Reason for leaving:
Employer:
Address:
Supervisor:
Phone:
Start date:
End date:
May we contact this employer?
Yes
No
Salary range:
Position/duties:
Reason for leaving:
Employer:
Address:
Supervisor:
Phone:
Start date:
End date:
May we contact this employer?
Yes
No
Salary range:
Position/duties:
Reason for leaving:
Have you ever been convicted of a crime?
Yes
No
If so, for what and where?
Please explain all periods of unemployment:
Please indicate at least two personal references not related to you, of whom you have known at least one year:

This institution does not discriminate in hiring or any other decisions on the basis of race, color, sex, religion, citizenship, national origin, or on the basis of age or physical or mental disability unrelated to the ability to perform the essential functions of the position.

I voluntarily give this institution the right to make a thorough investigation of my past employment and activities, agree to cooperate in such an investigation, and release from all liability or responsibility all persons, companies, or corporations supplying such information. I realize that my employment is based on a successful background check and a drug screen.

Any applicant for employment who willfully furnishes, supplies or other wise gives false information on an employment application that is the basis for a criminal history record check under this section shall be guilty of a Class A1 misdemeanor. {NCGS 131E-265(e)}

I understand that my employment is at will, and that either party is free to terminate the employment relationship at any time. I understand that The Forest is a Tobacco Free Employer, and as an employee of The Forest I am required to receive an annual influenza vaccine. I understand that my employment may be terminated for any falsification or omission of fact appearing on this application form. I also understand that enrollment in The Forest at Duke’s Payroll Direct Deposit Program is a condition of employment. I will abide by all Tobacco Free policies implemented by The Forest.

If I receive a conditional offer of employment, I will be required to complete an Employment Verification Form (I-9), and within three days show satisfactory evidence of identity and eligibility for employment.

Step 6: Availability

Primary position desired:
Are you available to work weekends?
Yes
No
Are you available to work holidays?
Yes
No
Are you available to work rotating shifts?
Yes
No
Do you have responsibilities that would limit your availability?
Yes
No
If yes, explain:

I understand that emergency conditions may require me to temporarily work shifts other than the one for which I am applying and agree to such scheduling changes as directed by the department director or administrator of this institution.