Application

  • Do not include any information that could be considered sensitive (SSN, Driver's License #, etc)
    Check all shifts that you are able to work
  • Employment History

    Please list the most recent first.
  • Personal References

  • Reference 1
  • Reference 2
  • Reference 3
  • Acknowledgement

    I hereby authorize Chardonnay Assisted Living (the company) to contact any company, person or educational institution I listed as a reference on my employment application. I hereby allow any company, person, or educational institution I listed as a reference on my employment application to disclose any information they may have regarding my qualifications for employment, including but not limited to employment dates, descriptions of jobs performed, salary and wage rates and personal attributes. I agree to release and discharge Chardonnay Assisted Living and Chardonnay Assisted Living’s successors, employees, officers, and directors as well as any company, person, or educational institution I have listed as a reference for all claims, liabilities, and causes of action, known or unknown, fixed or contingent, for providing or receiving any information regarding my qualifications for employment. This release includes but is not limited to claims of defamation, libel, slander, negligence, or interference with contract or profession.