NAPOLEON CARE CENTER 311 EAST 4TH STREET NAPOLEON, ND 58561 It is the policy of this facility to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability or any other reason prohibited by law.

Employment Application

  • Last, First, Middle I
  • MM slash DD slash YYYY
  • Education: High School

  • Education: College

  • Education: School of Nursing

  • Education: Special Schooling or Training

  • Professional license and certifications:

  • Employment History:

    (List all previous employers for whom you have worked during the last five years. Explain any lapses between times when employed).
  • please include your: start & end date (month/yr) - salary - position / location - supervision - reason for leaving
  • References

    List the names, addresses, and telephone numbers of people we can contact for professional recommendations. List at least one employer or former employer if possible.

    Military Service Record: The hiring and re-employment of veterans will be conducted in accordance with applicable state and federal laws and regulations.
  • CAUTION: PLEASE READ BEFORE APPLYING FOR EMPLOYMENT. I hereby state that the information given by me in this application, related papers, and interviews is true in all respects. I understand that Napoleon Care Center will investigate my work history and may verify any information given in my application, related papers or interviews. I hereby authorize my former employers to release information pertaining to my work record, my work habits, and my work performance. I agree that, if I am employed and the information I have given is found to be false in any respect, I will be subject to dismissal without notice at any time. I understand and agree that any employee handbook which I may receive will not constitute an employment contract, but will be merely a gratuitous statement of Napoleon Care Center's current policies. I understand that Napoleon Care Center reserves the right to require its employees to submit to alcohol or drug tests prior to and randomly throughout their employment with Napoleon Care Center. Napoleon Care Center also has the right to inspect bags(including purses or briefcases) or parcels brought into or taken out of the facility. I understand that refusal to submit to an alcohol/drug test or search, when requested to do so, may result in termination of my employment. I understand and agree that, if I am offered employment by Napoleon Care Center, my employment will be for no definite term and that either I, or Napoleon Care Center, will have the right to terminate the employment relationship at any time, with or without cause, and with or without notice and that this relationship can only be modified in writing and signed by the administrator.
  • NORTHERN TESTING - NOTICE OF CONSUMER REPORT This is to inform you that as part of our procedure for processing your employment application and at any time during your employment, Napoleon Care Center (hereafter referred to as The Employer) may obtain from a consumer reporting agency an investigative consumer report (background check) for employment purposes. In compliance with the Fair Credit Reporting Act, the reporting agency, Northern Testing, 3108 S. Broadway, Suite E, Minot, ND 58701: will not obtain such a report without your signed authorization. You understand that upon written request (within 60 days) to The Employer you will be informed whether an investigative consumer report was received and given full information as to the nature, scope and findings of the investigation. You understand that an investigative report is a report in which public and/or personal information may be obtained through personal interviews with known associates and public reporting agencies. Personal information can include, but is not limited to: Criminal & driving records, educational and employment, tests for illegal drugs, verifications, social security address trace, employment credit check, personal references, etc. By acknowledging below, you are authorizing The employer to obtain an investigative consumer report as part of the pre-employment background screening process. If The Employer offers you employment, you authorize The Employer to obtain additional investigative reports and retain those reports on file for the duration of your employment or longer if required and/or allowed by law. I hereby acknowledge that I have read the above disclosure statement and have understood it.
  • MM slash DD slash YYYY
  • Reset signature Signature locked. Reset to sign again


Napoleon Care Center
PH: (701) 754-2381
311 East 4th Street
Napoleon, ND 58561