Personal Information

Are you prevented from lawfully becoming employed in this country?

Do you have a record of founded child or dependent adult abuse?

Have you ever been convicted of a crime other than a simple misdemeanor offense relating to motor vehicles and laws of the road under chapter 321 or equivalent provisions in this state or any other state?


Employment Desired

Shift you can work: 

What Days? 

Hours desired:

Have you ever applied for this company before?

Have you ever worked for this company before?



List three persons we may contact excluding relatives (do not list relatives).

Reference 1

Reference 2

Reference 3

Former Employers

List below your work experience, starting with most recent first:

Employer 1Date Employed:

Employer 2Date Employed:

Employer 3Date Employed:

May we contact your present employer at this time?


Applicant’s Statement

These answers are true and complete to the best of my knowledge. I understand that this application is not a contract of employment and if hired, regardless of any oral representations of the contrary, the employment relationship between myself and Ridgecrest Village is terminable at will by either party with or without cause. All changes in this employment relationship must be made in writing.

This institution does not discriminate in hiring or any other decision on the basis of race, color, sex, citizenship, national origin, or on the basis of age or physical or mental disability unrelated to the ability to perform the work required. No question on this application is intended to secure information to be used for such discrimination.

I voluntarily give Ridgecrest Village the right to make a thorough investigation of my past employment, agree to cooperate in such investigation and release from all liability or responsibility all persons, companies or corporations supplying such information. I understand that a civil/criminal check will be conducted and any false or misleading information provided by me may result in my immediate discharge, if hired. I also indemnify Ridgecrest Village against any liability which might result from making such investigation. I consent to take the physical examination and such future physical examinations as may be required by this institution at such times and places as the institution designates. I consent to submit to a pre-employment drug screening as may be required by this institution at such times and places as the institution designates. Employment is contingent on passing pre-employment drug screen & background checks. Additionally, I authorize Ridgecrest Village to supply my employment record, in its sole discretion in whole or in part to any government agency or other part with an interest that Ridgecrest Village deems appropriate.