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Maunalani Nursing & Rehab Center

Climbing the heights for you...

Email: info@maunalani.org
Phone: (808) 732-0771
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You are here: Home / Employment Application

Employment Application

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  • I. Personal Information

    Upon hire, you will be required to present proof of age, authorization to work and your social security number.
  • Have you ever used other names? If so, please print (For background and criminal conviction check)
  • (xxx) xxx-xxxx
  • (xxx) xxx-xxxx
  • Can you, upon employment, submit verification of your legal right to work in the United States? [NOTE: If offered employment, you will be required to submit documentation required by IRCA.]
  • II. Employment Interest

  • *If hired, you will be required to perform work as required by Maunalani.
  • MM slash DD slash YYYY
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  • III. Education

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  • IV. Former Employers:

    Please account for the past five years of employment by answering all questions for each employer.
  • (xxx) xxx-xxxx
  • (xxx) xxx-xxxx
  • (xxx) xxx-xxxx
  • Please upload your resume which includes past jobs and job responsibilities. Acceptable files include: PDF, DOC, DOCX. And file size limit is 10MB.
    Drop files here or
    Accepted file types: pdf, doc, docx, Max. file size: 10 MB.
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    • V. Employment Gaps

      Explain any periods that you were not working during the past 10 years, other than due to personal illness, injury, or disability.
    • VI. REFERENCES

      List name and telephone number of three business/work references who are NOT related to you and are NOT previous supervisors. If not applicable, list three personal references who are NOT related to you.
    • (xxx) xxx-xxxx
    • Please enter a number from 0 to 120.
    • (xxx) xxx-xxxx
    • Please enter a number from 0 to 120.
    • (xxx) xxx-xxxx
    • Please enter a number from 0 to 120.
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    • VII. JOB SKILLS AND QUALIFICATIONS

      Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying. If driving is required for the job you are applying for, please provide your valid driver’s license number, expiration date, and state of issuance.
    • VIII. RELATED INFORMATION

      If you are a member of any job-related organizations (professional, trade, etc.) or have received any job-related awards or accomplishments, list and describe them. Exclude any information that would reveal your age, race, sex, religion, color, national origin, ancestry, marital status, disability, sexual orientation, arrest and court record or any other protected category recognized by Hawaii and federal laws.
    • I understand and agree that:

      1. The information in this application is true and complete and that any false or misleading information made in this application or interview(s) is grounds for disqualification from further consideration for employment or for dismissal from employment.

      2. This application is not a contract of employment. If offered employment, MY EMPLOYMENT WITH MAUNALANI IS AT-WILL AND CAN BE TERMINATED AT ANY TIME AND FOR ANY REASON WITH OR WITHOUT ADVANCE NOTICE BY MYSELF OR THE MAUNALANI.

      3. Maunalani may investigate my personal and/or employment history, excluding salary history. Any former employer, school, government agency, or other person/entity may provide Maunalani with any information they may have regarding me; provided the information does not pertain to salary history. If employed by Maunalani, Maunalani may provide truthful information (including fact or opinion) regarding my employment to any potential or future employer. I release Maunalani and all providers of such information from any liability which may arise as a result of furnishing and/ or receiving such information.

      4. I may be required to submit to drug testing and a post-offer medical examination as part of my application for employment. I may be required to submit to a medical examination during my employment with Maunalani, provided that such examination is job-related and consistent with business necessity. I authorize the physician or laboratory conducting such examination to disclose the results of the examination to Maunalani in accordance with state and/or federal laws. Maunalani will keep such results confidential unless allowed/required by law.

      5. Maunalani may inquire into and consider any criminal conviction record that I may have after it makes a conditional offer of employment. Maunalani may withdraw a conditional employment offer if I have a criminal conviction record which bears a rational relationship to the duties and responsibilities of the position for which I am applying. Any criminal conviction record that is more than 10 years old (excluding periods of incarceration) or that involves certain Family Court matters will not be considered.

      6. If hired, I shall not disclose or use confidential information belonging to prior employers and that I will inform Maunalani of any agreements that would limit my ability to work for Maunalani.

      7. All of the foregoing terms and conditions will become part of my employment relationship with Maunalani if I am employed by Maunalani.

    • MM slash DD slash YYYY
    • This field is for validation purposes and should be left unchanged.
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    Maunalani Nursing and Rehabilitation Center

    5113 Maunalani Circle
    Honolulu, HI 96816
    Phone: (808) 732-0771
    Email: info@maunalani.org

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