PERSONAL INFORMATION

• Print Name: *

• Date of Birth:*

• Date:*

• S.S.N.:*

• Address: *

• Telephone Numbers:*

• Position Applying for: *

• How did you hear about Moonlight Care?*

• Do you have any friends or relatives working for Moonlight Care? Who? *

• Please list any military services:*

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WORK HISTORY: PLEASE LIST YOUR WORK HISTORY BEGINNING WITH YOUR MOST CURRENT.

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• Name of Employer

• Address

• Phone Number

• Position

• Reason for Leaving

• Ending Salary

• Date of Hire

• Last Day

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• Name of Employer

• Address

• Phone Number

• Position

• Reason for Leaving

• Ending Salary

• Date of Hire

• Last Day

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• Name of Employer

• Address

• Phone Number

• Position

• Reason for Leaving

• Ending Salary

• Date of Hire

• Last Day

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EDUCATION:

• High School

• Year Graduated

• Accomplishments

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• College/Degree

• Year Graduated

• Accomplishments

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NON-RELATED PERSONAL REFERENCES: ( PLEASE LIST THREE.)

• Name

• Phone Numbers

• Relationship

• Years Known

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PLEASE LIST ALL SPECIAL SKILLS, TRAININGS, AND CERTIFICATIONS.

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PLEASE PROVIDE A SUMMARY OF WHY MOONLIGHT SHOULD HIRE YOU.

• Print Name

• Choose One Full TimePart Time

• Date you can begin work

• Shift Preferred

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PLEASE NOTE THAT ALL MOONLIGHT EMPLOYEES ARE REQUIRED TO WORK AN EQUIVALENT OF EVERY OTHER WEEKEND AND EVERY OTHER HOLIDAY. SHIFTS MAY VARY FROM 1 HOUR TO 12 HOURS. DUE TO THE NATURE OF SERVICES PROVIDED BASED UPON CLIENT NEEDS AND STAFFING NEEDS, YOU MAY BE ASSIGNED TO WORK OTHER SHIFTS.

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DURING THE INTERVIEW, REVIEWED AND DISCUSSED WITH APPLICANT THEIR AVAILABILITY.

• Applicant Signature / Date

• Moonlight Management Signature / Date

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PLEASE ANSWER ALL THE FOLLOWING QUESTIONS TRUTHFULLY AND THOROUGHLY.

• PLEASE DESCRIBE A TIME YOU MADE A MISTAKE ON THE JOB. HOW DID YOU FIND OUT ABOUT THE MISTAKE AND WHAT DID YOU DO TO CORRECT THE MISTAKE?
  

• PLEASE DESCRIBE THE BEST TEAM YOU WORKED WITH. WHAT ROLE DID YOU PLAY AS A TEAM MEMBER?
  

• PLEASE DESCRIBE A TIME YOU DISPLAYED UNPROFESSIONAL BEHAVIOR AT WORK. WHAT DID YOU LEARN FROM THIS?
  

• PLEASE DESCRIBE A TIME YOU HAD TO DEAL WITH A DIFFICULT CO-WORKER. HOW DID YOU HANDLE THE SITUATION?
  

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PLEASE READ CAREFULLY.

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I UNDERSTAND THAT ANY FALSE OR MISLEADING INFORMATION GIVEN IN MY APPLICATION OR INTERVIEW MAY RESULT IN DISCHARGE FROM EMPLOYMENT WITH MOONLIGHT. I AUTHORIZE AND GIVE MOONLIGHT PERMISSION TO CONTACT MY CURRENT AND PREVIOUS EMPLOYERS IN ADDITION TO MY PERSONAL REFERENCES. I UNDERSTAND I AM TO ABIDE BY ALL RULES AND REGULATIONS OF MOONLIGHT. I ATTEST THAT I AM OF 18 YEARS OF AGE OR OLDER.MOONLIGHT IS AN EQUAL OPPORTUNITY EMPLOYER. I UNDERSTAND MY EMPLOYMENT WITH MOONLIGHT IS “EMPLOYMENT AT WILL”. THE INFORMATION CONTAINED IN MY EMPLOYMENT APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE.

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• Signature

• Date

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ATTACHED TO THIS APPLICATION IS AN OFFENSE LIST AND DEPARTMENT OF HOMELAND SECURITY FORM. PLEASE CAREFULLY READ BOTH AND FILL OUT ALL REQUIRED ELEMENTS. BOTH COMPLETED FORMS ARE TO BE TURNED IN WITH YOUR APPLICATION. THANK YOU.

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