Position Desired * --Select Position-- Activities Director - Residences at Benning Metro Activity Assistant - River Mills Assistant Director of Nursing - Residence at Kenilworth Park Assistant Resident Care Director - Sunapee Cove Caregivers - Forestview Manor Care Providers - Maple Ridge Campus Certified Nursing Assistant – HHA - Residence at Kenilworth Park Certified Nursing Assistant - HHA - River Mills Certified Nursing Assistant - Windrose at Weymouth Charge Nurse - Maple Ridge Campus Companion CNA-HHA - Heywood Wakefield Commons Cook - Addison Place Cook - Brigham House Cook - Forestview Manor Cook - Prospect House Cook - Sunapee Cove Cook - Susan Bailis Cook - Windrose at Weymouth Cook - Windrose at Woburn Dining Room Supervisor - Residence at Kenilworth Park Dining Room Wait Staff - Maple Ridge Campus Dining Room Wait Staff - Sunapee Cove Dining Room Wait Staff - Susan Bailis Housekeeping - Sunapee Cove Kitchen Assistant - Maple Ridge Campus Licensed Nurses Assistant - RCA - Sunapee Cove Licensed Practical Nurse - Addison Place Licensed Practical Nurse - Residence at Kenilworth Park Maintenance Assistant - Brigham House Maintenance Director - Residence at Kenilworth Park Maintenance Director - Residences at Benning Metro Maintenance Technician - Maple Ridge Campus Move-in Coordinator - Residence at Kenilworth Park Receptionist - Residence at Kenilworth Park Registered Nurse and Licensed Practical Nurse - Sunapee Cove Resident Care Assistant - Brigham House Resident Care Assistant - Prospect House Resident Care Assistant - Susan Bailis Resident Care Director- Brigham House Resident Care Director DON - Windrose at Weymouth Resident Care Director - RN - Residence at Kenilworth Park Security Guard - Residence at Kenilworth Park Wellness Nurse - Brigham House Wellness Nurse - Prospect House Wellness Nurse RN/LPN - Heywood Wakefield Commons Wellness Nurse RN-LPN - Windrose at Weymouth Wellness Nurse RN-LPN - Windrose at Woburn Real Estate Development Manager - HKM Administrative Assistant - Ames Privilege Administrative Assistant Temporary - Wamsutta Preservation Assistant Property Manager - Box District Compliance/Recertification Specialist - Bayview Towers Maintenance Director - Courts of Camp Springs Maintenance Manager - Huntington Ave - Frawley Delle Maintenance Supervisor - Steinhorst Square Maintenance Supervisor - Villa Nueva Vista Maintenance Technician - Bayview Towers Maintenance Technician - Brook Apartments Maintenance Technician - Coolidge School - Residences at Fairmount Station Maintenance Technician - Courts of Camp Springs Maintenance Technician - Coyle School Residences Maintenance Technician - Oak Hill Apartments Maintenance Technician - Simpkins School Maintenance Technician - Woodland Apartments Property Management Bookkeeper - Courts of Camp Springs Property Manager - Copley Gardens Property Manager - Downtown Lofts Property Manager - Henry T. Wing School Resident Services Coordinator - Steinhorst Square and Brook Senior Property Manager - Pine Oaks Villages

Full / Part / Temp

Salary/Rate Desired

Hours Desired

Is there anything that would prevent you from working any day or time of the week or regularly working overtime?

No

Yes

If yes, please specify the reasons. It is not necessary for you to identify unavailability for work because of religious observance or practice or any other protected classification. Subsequent to any job offer, we will consider whether a reasonable accommodation can be made.

Have you ever been employed by us?

No

Yes

If yes, give date, location, title, name of supervisor and reason for leaving.

Have you ever applied for employment with us?

No

Yes

If yes, give date.

Do you have any friends, relatives, or acquaintances working for us?

No

Yes

If yes, please identify them.

How were you referred to this Company?

Friend/Family

Career Website

Other

If hired, will you have reliable transportation to and from work?

No

Yes

Go to Next Section

#1 Reference Name

Telephone

Email Address

#2 Reference Name

Telephone

Email Address

#3 Reference Name

Telephone

Email Address

Go to Next Section

High School

Course Of Study

Degree Or Diploma

College

Course Of Study

Degree Or Diploma

Graduate School

Course Of Study

Degree Or Diploma

Other Schooling (Vocational, Post-graduate)

Course Of Study

Degree Or Diploma

Go to Next Section

• Employer #1 - first most recent

Employer #1

Employer

Address / City, State

Name of Supervisor/Title

Telephone

Start Date:

End Date:

Summarize work performed and job responsibilities:

Reason for leaving:

• Employer #2 - second most recent

Employer #2

Employer

Address / City, State

Name of Supervisor/Title

Telephone

Start Date:

End Date:

Summarize work performed and job responsibilities:

Reason for leaving:

• Employer #3 - third most recent

Employer #3

Employer

Address / City, State

Name of Supervisor/Title

Telephone

Start Date:

End Date:

Summarize work performed and job responsibilities:

Reason for leaving:

• Employer #4 - fourth most recent

Employer #4

Employer

Address / City, State

Name of Supervisor/Title

Telephone

Start Date:

End Date:

Summarize work performed and job responsibilities:

Reason for leaving:

Applicant's Statement

I have read and fully understand the questions asked in this application. I certify that all of the answers I have given are true, accurate and complete. I understand that the omission and/or misrepresentation of any fact from or on this application or during any interview will result in immediate rejection of my application or if I am hired will be cause for immediate dismissal. Unless I noted otherwise, I authorize the Company to independently contact all my employment references and personal references, as well as the education institutions I have attended. I further authorize the Company to independently inquire about, investigate and obtain copies of any records which relate to me from my former employers and educational institutions. I hereby release the Company and all affiliated persons and entities, as well as any person or institution that provides the Company with any lawful information about me, from any and all liability whatsoever resulting from any such lawful independent inquiry, investigation or communication.

If hired, I understand that I will be required to abide by all of the rules and regulations of the Company. I understand and agree that nothing in this application shall constitute an offer, a contract or a guarantee of employment for a specific period of time. If hired, I understand that my employment may be terminated with or without cause and with or without notice at any time, at the will of the Company or me. I further understand that no representative or agent of the Company, other than the Senior Vice President of Human Resources has the authority to enter into any agreement for employment, on an individual or collective basis, for any specific period of time, or to make an agreement contrary to the foregoing. I also understand that any agreement modifying at-will employment status, on an individual or collective basis, must be in writing and signed by the Senior Vice President of Human Resources. In addition, I understand that the Company and all plan administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms and conditions of employment.

Name

eSignature

Date