Sonora Senior Living
Formerly Casa Viejos/Lic. #557-003-146

18760 Chabroullian Lane Jamestown . Ca 95321
209-984-5124 (Office) 209-984-0248 (Fax) (Email)

Thank you for choosing to apply for employment at Sonora Senior Living. (Formerly Casa Viejos)

The following questionnaire will help us place you in the job that best fits your needs.

Please take time to complete and turn it in with your application.

Your Address



Zip Code


Social Security #

Please Check The Appropriate Answer

Are You Over 18 Years Old?

What Job Are You Applying For?

Have You Ever Been Convicted Of A Crime In California, Another State Or In Federal Court?

(All employees working at Sonora Senior Living must pass a background clearance prior to working)

What Days Are You Available To Work?

What Hours Are You Available?

Have You Ever Had T.B. Or Been Exposed To T.B.?

Have You Ever Been Tested Positive For T.B. Using The Skin Test?

(If applicant needs a chest X-Ray for T.B. clearance, that is done at applicant's

Are You Able To Lift Up To 50 Pounds On A Regular Basis?

Do You Have A Current First Aid Card?

(First Aid Card is required for all Caregivers & Med Tech. The cost of the First Air Training is the responsibility of the Employee and typically runs between $20-$35)

Do You Have A Relative Working For Sonora Senior Living?
If Yes Please Include Their Name Below.

Do You Have Reliable Transportation To Work?

Applicant's Name/Signature
Today's Date