Welcome to St. Patrick's Residence Nursing and Rehabilitation. We are pleased that you are interested in employment with us. From the start, we want you to know who we are. Our Mission Along with the Carmelite Sisters for the Aged and Infirm, our mission is not only to staff and operate up-to-date homes for the aged and infirm, but to bring Christ to every elderly person in our care. Bringing Christ means giving the elderly His compassion, His interest, His loving care and His warmth. Our Core Values Christian Witness expressing and advocating values and beliefs of Christian Service at all levels of society. Hospitality providing a home-like atmosphere within the institutional setting. Pastoral Ministry nurturing a spirit of Christian Community and offering a supportive presence and spiritual consolation. Quality of Life providing love, respect and concern for each person through our healing ministry. Redemptive Suffering caring and compassionate responses for a person s pain, suffering and death. Roman Catholic Doctrine articulating and implementing Ethical Standards in the conduct and judgment of the facility. Sanctity of Life holding in reverential esteem the sacredness of life and the dignity of human person, creating an environment which recognizes Christ in every individual. Shared Commitment promoting a binding together through a common spirit, a shared sense of belonging, achievement, accountability, ideas, insights and feelings. Social Justice providing educational opportunities and employment within standards of fair labor practices. Wholistic Caring having quality programs and services encompassing total care and based on individual need and non-discriminatory values. We have developed standards of behavior which are based on our Mission and Core Values. Employees are evaluated annually on their performance and must demonstrate these values through their behavior. Do you see yourself working with us in our Ministry? (please check one) Yes, I look forward to working in a faith-based organization. I agree with your Mission and can commit to these Core Values. I am not sure I d like to speak with someone. I am qualified for the position I am applying for; however, I cannot commit to your mission and values. Print Name: Date: Signature:
IMPORTANT NOTICE TO ST. PATRICK'S RESIDENCE JOB APPLICANTS The State of Illinois requires background checks, including livescan fingerprinting on all unlicensed employees of certified long-term care facilities that have or may have contact with residents or access to the living quarters, or the financial, medical or personal records of residents (Illinois Administrative Code 955, Section 10). It is the policy of St. Patrick's Residence to conduct background checks, including livescan fingerprinting, on all employees, unlicensed or licensed, upon acceptance of a job offer. If you are seeking employment but will not agree to such an investigation, and to disclosing the information needed to start the investigation process, it is not necessary for you to complete the Employment Application. If a person has been convicted of one or more of the crimes listed in the Health Care Worker Background Check Act of 1996, they will not be hired or retained. The Illinois Department of Public Health (IDPH) may grant a waiver under provisions of Section 40 of the Health Care Worker Background Check Act. The granting of a waiver by the State of Illinois does not guarantee an individual will be offered employment or retained by St. Patrick's Residence. The information provided for the livescan fingerprinting process is solely for the purpose of identification. It will not be used to discriminate against any Applicant or employee of St. Patrick's Residence in any way. The form will be completed only after a job offer is made. By signing below, you indicate your understanding and acceptance of these terms. Print Name: Date: Signature: St. Patrick s Residence 1400 Brookdale Road Naperville, IL 60563-2126 (630) 416-6565 Fax: (630) 416-8755
APPLICATION FOR EMPLOYMENT An Equal Opportunity Employer PLEASE PRINT IN INK Applicants will receive consideration for employment without regard to any protected personal characteristic, including but not limited to race, color, creed, religion, national origin, sex, disability, age, marital or veteran status, sexual orientation and status with regard to public assistance or any other personal characteristic protected by federal, state or local law. Applications are kept on file for am minimum of one (1) year. You may update your application upon request. Applications will be considered at the time of receipt. This application must be completed in its entirety. Partial or incomplete applications may be cause for eliminating an applicant from consideration. A resume may be attached to the application but it will not substitute for completing the application. It is the policy of St. Patrick s Residence Nursing and Rehabilitation to conduct post-offer drug screening following a job offer. By initialing below, you understand that, as a condition of employment, you will be asked to undergo post-offer drug testing at no expense to you for the purpose of determining the presence of illegal drugs or prescription drugs used without a prescription. Your failure to consent to such a test or not having the test conducted within twenty-four hours of the offer, unless waived by St. Patrick s, or a verified positive drug test result will disqualify you from employment. You agree to hold all parties concerned harmless, meaning you will not sue nor hold responsible, for any alleged harm to you or for interfering with you obtaining a job or continuing employment, due to not submitting to the test or as a result of the report of the test. This includes, but is not limited to, possible clerical or laboratory error. You understand that you have the right to have a second test conducted at your expense. Employment is contingent upon the successful completion of a post-offer drug screen, criminal background check in accordance with Illinois Department of Public Health s Health Care Worker Background Check, employment/reference verification, physical and TB test. Please initial to verify that you understand the above statements: (initial) NAME: Last First Middle Initial DATE: Have you ever worked under another name? YES NO If YES, give name: ADDRESS: Number Street City State ZIP BEST PHONE # TO REACH YOU: EMAIL: POSITION DESIRED: DATE AVAILABLE: Full-time Part-time ( hours/week) Temporary From to Shift you prefer: Day Shift Afternoon Shift Night Shift Any Shift Hourly Rate/Salary desired: If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No If hired, you will be required to show that you are authorized to work in the US and to furnish proof of this within 3 days of hire. Can you do this? Yes No Have you ever filed an application with us before? Yes No If Yes, give date(s):
Have you been employed by St. Patrick s Residence in the past? Yes No If Yes, give date(s): Position held: Supervisor: Indicate all work experience beginning with your current or most recent positon. Include any job-related military service assignment and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disability or other protected status. Complete all sections. Provide dates of employment for jobs held in the last 10 years only. A resume providing this information may be attached as a supplement. We will contact former employers for references. Are you currently employed? Yes No May we contact your present employer? Yes No
High School (Name /Location): College (Name/Location): Graduated: Yes No Degree Completed: Other Education (schools, seminars, military): Complete this section if a license is required to perform the duties of the job for which you are applying. Type of License/Certification State Issued License/Certification Number Expiration Date If you don t have the required license for this job, have you applied for the license? Yes No If an exam is required to obtain the required license, give scheduled date: If not licensed in this State, have you applied for reciprocity? Yes No List any additional skills you have that add to your qualifications for this positon (i.e. EMT, CPR training, etc.) How did you hear about St. Patrick s Residence? Ad (Name of Publication: ) Current Employee (Name: ) Friend/Relative (Name: ) Walk-in Internet Employment Agency (Name: ) Other To complete the application, please turn this page over.
Nothing in this application or in the hiring process is to be construed as constituting a guarantee of employment. Individuals are free to resign at any time, just as St. Patrick's Residence is free to terminate employment at any time with or without cause or notice. While St. Patrick's Residence reserves the right to change an employee s position, title, job responsibilities or compensation at any time, with or without notice, the voluntary at-will employment relationship may not be modified by any oral or implied agreement. I agree that neither this application nor any personnel manual, which I may receive upon employment, is intended to be a contract of employment. I agree that any offer of employment is conditioned on (i) verification of my right to work in the United States; (ii) receipt of favorable references (as determined in the sole discretion of St. Patrick's Residence); (iii) successful completion of a post-offer drug screen and TB test. I agree that any offer of employment may also be conditioned on (i) demonstration of physical ability to perform essential job functions (all applicants are given the same testing); (ii) verification of any required license or registration and confirmation that no discipline, investigation or conditions will affect my ability to work under that license or the license of another, as determined by St. Patrick's Residence. AUTHORIZATIONS: I authorize all employers, agencies and other individuals or entities possessing relevant information to communicate freely with, and release information to, St. Patrick's Residence or its representative. A copy of this Employment Application form is valid for such authorization. I release St. Patrick's Residence and all individuals or entities providing information to St. Patrick's Residence from all claims or liabilities arising out of or related to such investigation or disclosure. I authorize St. Patrick's Residence to: (i) verify all statements contained in the Employment Application and any other information that I provide during the hiring process; (ii) make inquiries about my employment, education, military and/or criminal records; and (iii) obtain all other information it deems necessary in order to evaluate my application for employment. By signing below, I certify that all statements made by me in this Employment Application and all other information I provide during the application process, are or will be, true and complete. I acknowledge that any misrepresentations, falsifications, or omissions may be cause to reject my application, or result in termination of my employment if I am hired. Applicant Signature: Today s Date: To Submit Your Application: By Mail: St. Patrick s Residence Attention: Human Resources 1400 Brookdale Road Naperville, IL 60563 By Fax: 630-753-1580 By E-Mail: hr@stpatricksresidence.org Or deliver to our reception desk between the hours of 9:00 am to 7:00 pm