Eudaimonia Sober Living and Extended Care

Employment Application


Nova and ERH Logo 2100 x 600

Nova Recovery LLC is an Equal Opportunity Employer. Employment offers are made on the basis of qualifications and without regard to race, sex, religion, national or ethnic origin, disability, age, veteran status, or sexual orientation.

Please type or print. Complete the entire application. You may attach a resume, but you must still complete all questions. If the application is not completed fully, it will be deemed incomplete and may not be considered.

PERSONAL INFORMATION

Position Applying For:

 

Name (LAST, FIRST, MI):

 

Street Address:

 

City, State, & Zip:

 

Telephone Number:

 

Other Number:

 

Email Address:

 

Are you legally authorized to work in the United States? 

 

Are you under 18 years of age?  

 

Are you related to any current Nova Recovery LLC employee?  

 

If yes, their name and their relationship to you:  

Have you ever been employed by Nova Recovery LLC?

If yes, dates of employment and reason for leaving:

If required for position, do you have a valid driver’s license in good standing?

If yes, state of issuance, license #, and expiration date:

How did you hear about this employment opportunity at Nova Recovery LLC?   

 

EDUCATION & SKILLS

 

High School/GED Name:   

Address:   

Did you graduate? 

 

Degree:   

College Name:   

Address:   

Did you graduate? 

 

Degree:   

College Name:    

Address:    

Did you graduate? 

 

Degree:    

Other School Name:   

Address:    

Did you graduate?   

Degree:    

Other credentials/licenses/skills/etc. which are relevant to the job:   

WORK EXPERIENCE

Please detail your work history. Begin with your current or most recent employer. If you held multiple positions within the same organization, detail each position separately. Attach additional sheets if necessary. Omission of prior employment may be considered falsification of information. Please explain any gaps in employment. Include full-time military or volunteer commitments. Please do not complete this information with the notation “See Resume.”

Dates Employed:

 

Title:

 

Organization Name:

 

Phone:

 

Address:

 

Starting/Final Salary:

 

 

Primary Duties:

 
 

Reason for Leaving:

 

Supervisor’s Name, Title, & Phone:

 

Contact My Current References:

 

 

 

Dates Employed:

 

Title:

 

Organization Name:

 

Phone:

 

Address:

 

Starting/Final Salary:

 

 

Primary Duties:

 
 

Reason for Leaving:

 

Supervisor’s Name, Title, & Phone:

 

Contact My Current References:

Dates Employed:

 

Title:

 

Organization Name:

 

Phone:

 

Address:

 

Starting/Final Salary:

 

 

Primary Duties:

 
 

Reason for Leaving:

 

Supervisor’s Name, Title, & Phone:

 

Contact My Current References:

Equal Employment Opportunity Form

VOLUNTARY INFORMATION

This information is being requested in accordance with federal regulations. The information is voluntary and will not be used when considering you for employment with our company.

What is your race/ethnicity? Please mark the one box that describes the race/ethnicity category with which you primarily identify.

Gender

Military Service

ACKNOWLEDGEMENT & AUTHORIZATION

PLEASE READ CAREFULLY BEFORE SIGNING:

I read and understand the position description and can perform the essential functions with or without a reasonable accommodation. I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize Nova Recovery LLC to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a criminal background investigation and screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employees of Nova Recovery LLC serve at-will, and the employment relationship may be terminated at any time by either party, for any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States and to comply with company and departmental regulations. I understand that if employed on a temporary basis, I would be paid for hours worked only, and would be ineligible for benefits including paid time off. I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. I understand that the first THREE MONTHS of regular employment represent a provisional period, during which I would not be eligible to apply for transfer or promotion and during which I may be terminated without right of appeal.

A Nova Recovery LLC Company

 

 APPLICANT’S SIGNATURE (Void unless signed and dated) 

Optional Resume Upload

Leave this empty:

Eudaimonia Sober Living and Extended Care http://www.eudaimoniahomes.com
Signature Certificate
Document name: Employment Application
Unique Document ID: 603dc625f1c832f09ed1833634965586805e9d9a
Timestamp Audit
2015-11-22 16:04:51 CDTEmployment Application Uploaded by Mat Gorman Gorman - mat@novarecoverycenter.com IP 66.68.166.174