Elktonhc Nursing And Rehabilitation Center
MD 21921

Phone: 410-398-6474

Application For Employment

Your message has been sent. Thank you!

Personal Information

Are you over the age of 18: :


Employment Desired

Position :
For Nursing positions: Preferred Shift :
Are you now employed?:
if so, may we inquire of your present employer?:
Have you ever applied to this company before?:

EMPLOYMENT HISTORY (List below your last four employers, starting with the most current)


References (List below three persons not related to you, whom you have known at least one year)

Name Address & Phone Number Position Years Acquainted
Have you ever been convicted of any violation of the law other than minor traffic violations?

Under Maryland Law, an employer may not require or demand any applicant for employment or prospective employment or any employee to submit to or take a polygraph, lie detector or similar test or examination as a condition of employment or continued employment. Any employer who violates this provision is guilty of a misdemeanor and subject to a fine not to exceed $100. Elktonhc Nursing And Rehabilitation Center will abide by this law and will not require this as a condition of employment or continued employment.

If you are to be hired by the Company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.


I certify that the facts contained in this Application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company.

I understand that any employment is conditioned on a background check. I therefore authorize the Company to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the Company, without giving me prior notice of such disclosure. In addition, I release the Company, any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be “at will” and without fixed terms, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the Company unless made in writing.

I understand that filling out this form does not indicate that there is a position open and does not obligate the Company to hire. If hired, I agree to abide by all Company work rules, policies and procedures. The Company retains the right to revise its policies and procedures, in whole or in part, at any time.

Printed Name

Submission Date

Signature of Applicant

(Please click on save button in order to save your signature)
Signature uploaded successfully