Employment Application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Applicant Information - Step 1 of 4Position Applying For *Select position from the drop downAccount ExecutiveAssistant Clinical DirectorCertified Occupational Therapy AssistantClinical ManagerChaplain/Spiritual Care CoordinatorCNA/Home Health AideCommunity Liaison/Account ExecutiveHospice Aide/CNAHospice VolunteerIHSS AttendantInsurance Verification/Authorization SpecialistIRSS ProviderLPNMedical Social WorkerNurse PractitionerOffice CoordinatorOccupational TherapistPersonal Care WorkerPhysical TherapistPhysical Therapist AssistantQuality Assurance NurseRegistered NurseSpeech TherapistName *FirstLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone Number *Email *Other names under which you have attended school or been employedAre you eligible for work in the United States? *YesNoHave you ever been employed by Craft Health? *YesNoIf yes, list the dates of employment and reason for leavingAre you related to any current Craft Health employee? *YesNoIf yes, please list their name and relationship to youIf driving is required for the position, do you have a valid driver's license?YesNoIf yes, list the state of issuance, license # and expiration dateNextEducationHigh School or GED (please list the name of the school, city & state) Did you graduate?YesNoOther school (please list the name of the school, city & state)Did you graduate?YesNoCollege (please list name of school(s), city & state, degree received and major)Did you graduate?YesNoIf No, please list number of years left to graduateOther credentials/licenses/professional affiliations, etc which are relevant to the job for which you are applyingSkillsPlease list technical skills, clerical skills, trade skills, etc relevant to this position. Include relevant computer systems and software packages of which you have working knowledge and note your level of proficiency (basic, intermediate, expert)PreviousNextWork ExperiencePlease detail your work history. Begin with your current or most recent employer. If you held multiple positions with the same organization, detail each position separately. Omission of prior employment maybe considered falsification of information. Please explain any gaps in employment. Include full-time military or volunteer commitments. PLEASE DO NOT complete this information with the notation "See Resume." PLEASE NOTE: Craft Health reserves the right to contact all current and former employers for reference information.Dates Employed (List start and end dates) - please fill in details and do not type "See Resume" *Select one *Full-timePart-timeIf part-time, list the number of hours/weekTitle *Organization Name and Address *Supervisor's Name, Title and Email or Phone # *Other Reference Name, Title and Email or Phone #Primary duties *Reason for leaving *May we contact this employer? *At any timeOnly if I am a finalist candidateEmployer #2 - please fill in details and do not type "See Resume"Dates Employed (List start and end dates)Select oneFull-timePart-timeIf part-time, list the number of hours/weekTitleOrganization Name and AddressSupervisor's Name, Title and Email or Phone #Other Reference Name, Title and Email or Phone #Primary dutiesReason for leavingMay we contact this employer?At any timeOnly if I am a finalist candidateEmployer #3 - please fill in details and do not type "See Resume"Dates Employed (List start and end dates)Select oneFull-timePart-timeIf part-time, list the number of hours/weekTitleOrganization Name and AddressSupervisor's Name, Title and Email or Phone #Other Reference Name, Title and Email or Phone #Primary dutiesReason for leavingMay we contact this employer?At any timeOnly if I am a finalist candidateEmployer #4 - please fill in details and do not type "See Resume"Dates Employed (List start and end dates)Select oneFull-timePart-timeIf part-time, list the number of hours/weekTitleOrganization Name and AddressSupervisor's Name, Title and Email or Phone #Other Reference Name, Title and Email or Phone #Primary dutiesReason for leavingMay we contact this employer?At any timeOnly if I am a finalist candidateAttach additional sheets to document previous work experience Click or drag a file to this area to upload. PreviousNextReferences (if different than listed under Work Experience). **At least two references must be listed on your application**Reference #1 NameFirstLastRelationshipEmail (preferred) or Phone #Years KnownReference #2 Name FirstLastRelationshipEmail (preferred) or Phone # Years Known Craft Health is an Equal Opportunity Employer committed to excellence through diversity and does not discriminate in hiring based on federally-protected classifications and additional protected classifications under Colorado and local law. I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize Craft Health to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that employees of Craft Health are at-will, and the employment relationship may be terminated at any time by either party, or any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States and to comply with Craft Health regulations. I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. **If you need help with filling out this application form or during any phase of the application or interview process, please notify Human Resources and every reasonable effort will be made to accommodate your needs in a timely manner.** I understand that by typing my name below and clicking on "Submit," I am electronically signing this document and am certifying that I have read, understand and accept this information. *Date *Previous Submit