Job Application – Soley Leve Adult Day Health

Signature Disclaimer

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my employment being terminated.
Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment.

TEAR OFF SHEET

Soley Leve Adult Day Health, does not discriminate against qualified based upon any protected group status, including but not limited to race color creed, religion, sex (Except where it is a bona fide occupational qualification), national origin ancestry, age, marital status, military or veteran status, sexual orientation, physical or mental disability or medical condition as defined by applicable equal opportunity laws.

To help us comply with federal/state equal opportunity record keeping, reporting and other legal requirements, we would appreciate you voluntarily providing the information below.

Gender

Female Male I do not wish to enter voluntary self-identification EEOC information

Hispanic or Latino ( a person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin regardless of race. White or Caucasian (not Hispanic or Latino) A person having origins in any of the original peoples of Europe, the middle East, or North Africa African American or Black (Not Hispanic or Latino) A person having origins in any of the black racial groups of Africa. Asian (Not Hispanic or Latino) A person having origins in any of the originals peoples of the far East, Southeast Asia, or the Indian subcontinent including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Island, Thailand, and Vietnam. Native Hawaiian or other Pacific Island (Not Hispanic or Latino) A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Island. American Indian or Alaska Native ( Not Hispanic or Latino) A person having origins in any of the original peoples of North and south America ( including Central America) and who maintain tribal affiliation or community attachment. Two or more Races (Not Hispanic or Latino) all person who identify with more than one of the above five races I do not wish to enter voluntary self-identification EEOC information

Employment Application