Copperleaf Management Group

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Copperleaf Senior Living Application

Copperleaf Senior Living provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Those applicants requiring the reasonable accommodation to the application and/or interview process should notify a representative of the organization.

Personal Information

Current Address

Employment Desired

Are you willing and able to work overtime if necessary?

Is this the first time you have applied with our organization?

Can you submit proof of legal employment authorization and identity?

If you are under 18, can you furnish a work permit if required?

Have you been convicted of a crime in the last 7 years? (will not automatically bar employment)

(name, years completed, degree)




Reference 1

Reference 2

Reference 3

Employment History

Employer 1

Employer 2

Employer 3

May we contact previous employers?

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decision and all other persons or organizations for providing such information.I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancelation of this application or immediate termination of employment if I am employed, whenever discovered. If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either the employer or I can terminate therelationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law. I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA. I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within this time shall result in immediate termination of employment.

I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.