Embracing Our Past. Building The Future.

Application for Employment

Vanguard Eldercare Medical Group, and its affiliated entities (collectively, "VGEMG"), is an Equal Opportunity employer. All qualified Applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran Status. This Employment Application will not be used for limiting or excluding any Applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify a VGEMG Human Resources Representative at (888) 837-5440.

VGEMG defines an "Applicant" as an individual who applies to a current open position through the internet or related electronic data technology or via a recruiting agency or employee referral, meets the basic job qualifications, and is considered for the position.

You can also download a PDF version of this application here.

Applicant Questions

Name:
Other Name(s) Used:
Current Address:
Prior Address:
Home Phone Number:
Cell Phone Number:
Email Address:
Specific position desired:
Salary desired:
Date Available to Start:
Type of employment desired:
           
Will you relocate?
Are you available to work on-call?
Are you excluded from payment from any major insurance provider, such as CMS?
If yes, provide details without revealing any criminal arrests/convictions:
Driving to/between long-term care facilities is an essential requirement of a clinical position with VGEMG.
Will you travel/drive?
Do you have a current valid driver's license?
Do you own reliable transportation?
Has your driver's license ever been limited, suspended, or revoked?
(answer "No" if your conviction or arrest was expunged)
How did you hear about VGEMG?
Have you submitted an application to VGEMG before?
If yes, provide dates and position(s)?
Have you ever been employed by VGEMG before?
If yes, provide dates and position(s)?
If yes, what was your reason for leaving?
Do any of your relatives work for VGEMG?
If yes, please complete:
Name
Relationship
Location
Have you entered into an agreement with any former employer or other party (such as a non-competition agreement) that might, in any way, restrict your ability to work for VGEMG?
If yes, please explain:
If hired, can you provide documents required to establish your citizenship and/or eligibility to work in the U.S.?

Education

High School or last grade completed

Name & City/State of School:
Number of years completed:
GPA/Class Rank:
Diploma/GED:

College or Technical School

Name & City/State of School:
Course of Study:
Number of years completed:
GPA/Class Rank:
Major/Minor:
Degree/Diploma:
Dates Attended:

College or Technical School

Name & City/State of School:
Course of Study:
Number of years completed:
GPA/Class Rank:
Major/Minor:
Degree/Diploma:
Dates Attended:

Graduate School

Name & City/State of School:
Dates Attended:
Number of years completed:
GPA/Class Rank:
Course of Study:
Degree/Diploma:

Graduate School

Name & City/State of School:
Dates Attended:
Number of years completed:
GPA/Class Rank:
Course of Study:
Degree/Diploma:
What type of Clinician are you?
*If Other:
Nurse Practitioner Certification
If yes, type:
Are you State Licensed or will be Licensed?
If yes, State:
License Number:
Has your License, DEA, or Prescriptive Authority ever been limited, suspended, revoked, or voluntarily surrendered?
Other Schooling or Specialized Training:

Military Experience

Do you have any Military Experience?
If yes, type:
Branch of Service:
Rank/Type of Service:
Date of discharge:
Number of years served:
Military Training/Experience that would be an asset for this position:

Special Skills and Qualification

Summarize any additional special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying for:
Computer Skills (Please include software titles and years of experience using them):
To what job-related organizations (professional, trade, etc.) do you belong? (Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve, national guard, union affiliation or any other similarly protected status.):
Please list special accomplishments, publications, awards, etc. (Exclude information that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve, national guard, union affiliation or any other similarly protected status.):
Is there any other job-related information not addressed in this application that you want us to know about you?

Employment (List positions starting with most recent)

Current Employer:
Telephone:
Address:
Position/Title:
Supervisor:
Start/End Date:
Beginning Salary:
Ending Salary:
Commission/Bonus/Other Compensation:
Reason for Leaving:
Can we contact?
Duties:
Employer:
Telephone:
Address:
Position/Title:
Supervisor:
Start/End Date:
Beginning Salary:
Ending Salary:
Commission/Bonus/Other Compensation:
Reason for Leaving:
Can we contact?
Duties:
Employer:
Telephone:
Address:
Position/Title:
Supervisor:
Start/End Date:
Beginning Salary:
Ending Salary:
Commission/Bonus/Other Compensation:
Reason for Leaving:
Can we contact?
Duties:
Employer:
Telephone:
Address:
Position/Title:
Supervisor:
Start/End Date:
Beginning Salary:
Ending Salary:
Commission/Bonus/Other Compensation:
Reason for Leaving:
Can we contact?
Duties:
Have you worked under your other name for any of these above employers?
If yes, please explain:

Work-Related References (Please do not include relatives)

Name
Company Name
Title (Supervisor, Co-Worker, etc.)
Phone Number
Number of Years Known

Applicant Statement (Please read this statement carefully before signing this Application)

I certify that all of the information I have provided herein to Vanguard Eldercare Medical Group, and/or its affiliated entities (collectively, “VGEMG”), is true, complete, and correct. If VGEMG discovers, at any time, that I failed to completely and honestly provide any requested information in this Employment Application or during the interview process, I understand that my Application will no longer be considered, or if I am working for VGEMG, I will be subject to disciplinary action, up to and including termination.

I understand that if VGEMG chooses to make me an offer of employment, this offer will be contingent upon the successful completion of a credentialing and criminal history background investigation about me from a consumer reporting agency, and, depending on the position offered, psychometric testing. Under the Federal Fair Credit Reporting Act of 1970, as amended, VGEMG will request in writing my authorization for the disclosure of my driving record, criminal/civil history, and investigative consumer report. Disclosure of a criminal record or pending charges will not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be taken into account.

All Applicants: Any requested driver’s license information may be used to verify your personal information and driving history. By signing this application, you authorize VGEMG to obtain personal information contained in your driving records if permitted under state law.

Indiana Applicants: VGEMG will not review any criminal records that have been sealed or restricted.

Michigan Applicants: VGEMG will not review any misdemeanor arrests that have not resulted in a criminal conviction. We reserve the right to request from you copies of criminal conviction records.

I expressly authorize VGEMG to contact anyone that it deems appropriate to verify the statements and information I have provided in this Employment Application in order to further investigate my background, past performance, and suitability for employment. This includes, but is not limited to, obtaining information from all references, employers, public agencies, licensing authorities, and educational institutions. I release from liability and consent to being discussed by any person contacted by VGEMG, and waive all rights and claims I may have against VGEMG for obtaining and using truthful, non-defamatory information in the employment process, or against anyone that provides information to VGEMG with the good faith belief that the information is true.

VGEMG does not tolerate unlawful discrimination or harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status in its employment practices. I understand that no question on this application will be used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of sex, race, color, religion, national origin, citizenship, age, disability, protected Veteran Status, or any other protected status under applicable federal, state, or local law.

I understand that this Employment Application is not an offer of employment and nothing contained in this Employment Application constitutes an employment agreement or contract. Assurances or promises to the contrary—oral, written, or implied—are invalid unless they are in writing and signed by an Officer of VGEMG. I UNDERSTAND THAT IF I AM HIRED, AND UNLESS I SIGN A WRITTEN EMPLOYMENT AGREEMENT FOR TERM, I WILL BE AN EMPLOYEE “AT WILL,” MEANING I AM NOT HIRED FOR ANY DEFINITE LENGTH OF TIME, AND EITHER I OR VGEMG CAN TERMINATE MY EMPLOYMENT AT ANY TIME FOR ANY OR NO REASON, WITH OR WITHOUT CAUSE, WITH OR WITHOUT NOTICE. You acknowledge that no oral or written statements or representations can alter your at-will employment status, except for a written Employment Agreement for Term or a written statement signed by you and an authorized VGEMG Officer.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States, including the completion of an I-9 Form.

As a condition of my employment, I understand and agree that I will be expected to abide by all of VGEMG’s rules, regulations, and policies set forth in VGEMG’s Employee Handbook or other communications distributed by VGEMG. I understand that testing for illegal drugs will be administered to all final candidates for whom an offer has been extended. I understand that VGEMG may request mandatory random drug testing, at any time, in accordance with applicable federal, state, or local laws.

If employed, I also understand and agree that VGEMG retains the sole right in its business judgment to modify, suspend, interpret, or cancel, in whole or in part, at any time, with or without notice, any published or unpublished policy, practice, procedure, process, or benefit, unless it is otherwise set forth in any written Employment Agreement.

I understand that this Employment Application remains current for one (1) year. At the conclusion of that time, it will be necessary to reapply and fill out a new application in order to be considered for employment.

Signature

DO NOT SIGN UNTIL YOU HAVE READ THE APPLICANT STATEMENT ABOVE.

Electronic Signature:
Printed Name of Applicant:
Date Signed: