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List your employers starting with your present or most recent.

Employer Information #1
Do you have certification (DHS 83 approval number course) in any of the following: (Check all that apply)

Please List 3 Professional References:

Reference #1


Sunset Ridge Johnson Creek operates under the philosophy of non-discrimination for all employees regardless of race, origin, color, religion, gender, marital status, sexual preference, veteran status, or disability. Employment decisions will be made on the basis of competency to state or national licensure and/or certification. A criminal background check is required by the State of Wisconsin, the results of which may prohibit employment under State of Wisconsin DHS 83 regulation. By DHS 83 regulation, all employees are required to be at least 18 years of age.

  • I certify that my answers are true and complete to the best of my knowledge. I authorize Sunset Ridge Johnson Creek to investigate this information by contacting my present or former employers and listed references.
  • If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
  • By typing my name below I agree to this disclaimer, and acknowledge that all answers given here in, are true statements.

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