Become a Part of the Lincoln Glen Community!

Lincoln Glen staff are reliable, responsible and have cared for our residents for years. Our staff longevity has created not just a senior facility, but a family, a community of caring. All of these factors have earned Lincoln Glen Manor the reputation of offering compassionate skilled care.

ADA Accessible APPLICATION FOR EMPLOYMENT

LINCOLN GLEN MANOR FOR SENIOR CITIZENS
2671 Plummer Ave, San Jose, CA 95125
(408) 265-3222   * Fax (408) 265-2839

In an email or letter, please provide following information:

1. Date of Application:

2. Personal Information:

Full Name
Last 4 Digits of your Social Security Number
Have you ever been employed under another name? List the other names.
What is your current address? Street Number, City, State, Zip
Telephone Number
Cell phone Number
Email Address

3. Employment Desired

Date you can start work.
List the position(s) desired.
List the shifts that you are you available to work: weekends, holidays, rotating shifts, on call?
Do you want to work full time, part time, temporary, regular, summer employment?
If you are seeking part-time work, specify the number of days per week.

Note: Lincoln Glen operates seven days a week/24 hour a day. For this reason, associates will have a variety of scheduled days and times for work and may be asked to work on weekends and holidays to accommodate business needs. Employees are expected to comply with the department schedules they are given.

4. General Information

Note: Prior to employment, all applicants will be required to be fingerprinted in compliance with the Department of Social Services.

Note: Please copy the following questions and answer them yes or no and additional information as needed.

Are you either a U.S. citizen or authorized to work in the U.S?
Are you 18 or older?
If you are over 16 but not yet 18, can you show proof of a work permit?
Have you ever been disciplined for resident abuse?
Have you ever been disciplined for child abuse?
Do you have relatives or friends employed at this company?
What are their names?
Have you ever been employed by Lincoln Glen?
If yes, dates, position, and department employed.
Have you ever applied to this company before?
If yes, when did you apply?
How were you referred? Newspaper or Internet Ad, Friend/Relative, Job Fair, Employee, Rehire, Career Day or Other source.

5. Employment History. Beginning with your current or last employer, list the last 3 positions of employment held by date.

Name of current or last employer?
Telephone number
Address including Street Number, City, State and Zip
When may this employer be contacted? Now or after offer of employment?
Name, title and phone number of supervisor
List the start and end dates for this job.
How many hours per week did you work?
What was the name of the position?

Name of second most recent employer?
Telephone number
Address including Street Number, City, State and Zip
When may this employer be contacted? Now or after offer of employment?
Name, title and phone number of supervisor
List the start and end dates for this job.
How many hours per week did you work?
What was the name of the position?

Name of third most recent employer?
Telephone number
Address including Street Number, City, State and Zip
When may this employer be contacted? Now or after offer of employment?
Name, title and phone number of supervisor
List the start and end dates for this job.
How many hours per week did you work?
What was the name of the position?

6. Record of Education

Please list the name of your high school, city and state, list some of the courses you studied, number of years you attended the school and diploma you earned.

Please list the name of your college, city and state, what courses you studied, number of years you attended the school and diplomas or degrees you earned.

Please list the name of other colleges, technical or training institutions, city and state, what courses you studied, number years you attended and any diplomas or certificates you earned.

7. If Licensed, Registered or Certified

Please list any professional licenses you hold. Include the type of license, the license number, state that issued the license, expiration date.

8. Interview and Comments

Note: Interviewer will add the interview date, their name and comments to  this document.

9. References

Note: Please complete even if only one or no employment references are listed. If you have no employment references, you may include persons in academic institutions, volunteer organizations, etc. not friends, relatives, or clergy.)

List the Name, Address, Telephone and Relationship of 3 references.

10. References Verified

Note: Interviewer will add references verified, by phone or mail and date of contact, the name of the person spoken to, comments and the name of the person checking the references.

11. Record Information Release

Note: Please print and sign the following 1 page Record Information Release and Certification form. If you are unable to complete this task, please let the interviewer know and they will provide the form and help you with the signature and date format.

To Whom It May Concern:
I have applied to Lincoln Glen for employment. To enable Lincoln Glen to properly evaluate my qualifications, I request and authorize you to release and furnish to Lincoln Glen any and all information in your records or files, or within your knowledge, concerning my present and /or past employment with you.

I authorize all persons, schools, current employers, previous employers, and organizations named in this application or provided by me to the facility to provide any relevant information that may be requested by the facility. I also hereby release all parties seeking and providing information from any and all liability or claims for damages whatsoever that may result from this information’s release, disclosure, maintenance, or use.

Signature of Applicant

Date

Printed Name of Applicant

Other Name(s) while employed

In consideration of my employment I agree to conform to all of the rules and regulations of this facility and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either this facility or myself. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by this facility. I understand that no representative of this facility, other than its Administrator, has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.

I certify that I have read and understand the foregoing paragraphs. I further certify that all the information submitted by me on the application is true and complete to the best of my knowledge, and I understand that any false information, omissions, or misrepresentations of facts called for on this application may be cause for the denial of my application or, if I am employed, discharge at any time.

As a condition of employment, I hereby consent to testing for drug and alcohol use, as determined to be appropriate by management, either before being hired or at any time during my employment with this facility.

Signature

Date

12. Items to be completed by employee after employment

Note: After you have completed the interview and have been employed, we will ask you to complete another form that requires the following:

Date of Birth
Maiden Name (if applicable)
Your Preferred Pronoun
Person to notify in case of emergency, their relationship, street address, citiy, state and telephone number

13. Acceptance Data Items will be completed by employer

Note: After you have been hired, your interview team will complete Acceptance Date which includes the date of the interview, your part-time or full-time status, your temporary or permanent status, hours, start date, job title, and department, Salary rate, either monthly or hourly and the signature of your Department Director.

14. Background Check Process

Please read before completing fingerprinting process.

Lincoln Glen Nursing Facility completes a background check on all employees. Unfortunately, we understand that this may eliminate potentially great employees from being hired as some of us have things in our past, even from a long time ago. Sometimes it has been so long we have forgotten or think that it may not be revealed.

The Law

The California Health and Safety Code requires a background check of all applicants, licensees, adult residents, volunteers under certain conditions and employees of community care facilities who have contact with clients. If the California Department of Social Services finds that an individual has been convicted of a crime other than a minor traffic violation, the individual cannot work or be present in any community care facility unless they receive a criminal record exemption from the Community Care Licensing Division, Caregiver Background Check Bureau (CBCB). Simply defined, an exemption is a Department authorized written document that exempts the individual from the requirement of having a criminal record clearance. CBCB also examines arrest records to determine if there is a possible danger to clients (Health & Safety Code sections 1522, 1568.08, 1569.17, and 1596.871).

How the Background Check is Conducted

When an individual submits fingerprints, the California Department of Justice (DOJ) conducts a background check. If the individual has no criminal history, DOJ will forward a clearance notice to the applicant or licensee and to CBCB. If the individual has a criminal history, DOJ will send a criminal record transcript to CBCB. The transcript will show arrests and convictions. CBCB staff will review the transcript and if the convictions are for crimes that can be exempted, CBCB will send an exemption notification letter to the applicant or licensee and to the individual.

All convictions other than minor traffic violations, including misdemeanors, felonies and convictions that occurred a long time ago require an exemption. However, individuals convicted of serious crimes such as robbery, sexual battery, child abuse, elder or dependent adult abuse, rape, arson or kidnapping are not eligible for an exemption. Lincoln Glen will not offer exemptions for new hires at this time.

The Department of Social Services is prohibited by law from granting exemptions to individuals convicted of certain crimes and provides a current list of Non-Exemptible Crimes.

Please review this information and let us know if you would like us to halt the hiring process. No questions will be asked. You may call or email us and request that we withdrawal your application if you believe that you are not going to be eligible for employment due to events that may be revealed through the background check.

We hope that you find this information helpful. Thank you for your understanding.

Link to Source Reference: Community Care Licensing Website: https://cdss.ca.gov/inforesources/community-care-licensing