Employment Application
Applicant Information
Full Name:
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Date:
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Last
First
M.I.
Address:
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Street Address
Apartment/Unit #
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City
State
ZIP Code
Phone:
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Date Available:
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Social Security No.:
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Desired Salary:
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Position Applied for (CNA, PCA, Dietary Aide, Cook, Housekeeping, Maintenance) :
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Are you a citizen of the United States?
YES
NO
If no, are you authorized to work in the U.S.?
YES
NO
Have you ever worked for this company?
YES
NO
If yes, when?
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Education
High School:
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Address:
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From:
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To:
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Did you graduate?
YES
NO
Diploma:
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College:
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Address:
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From:
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To:
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Did you graduate?
YES
NO
Degree:
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Other:
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Address:
_Click or tap here to enter text.
From:
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To:
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Did you graduate?
YES
NO
Degree:
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References
Please list three professional references.
Full Name:
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Relationship:
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Company:
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Phone:
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Address:
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Full Name:
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Relationship:
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Company:
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Phone:
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Address:
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Full Name:
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Relationship:
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Company:
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Phone:
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Address:
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Previous Employment
Company:
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Phone:
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Address:
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Supervisor:
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Job Title:Click or tap here to enter text.
Starting Salary:
$Click or tap here to enter text.
Ending Salary:
$Click or tap here to enter text.
Responsibilities:
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From:
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To:
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Reason for Leaving:
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May we contact your previous supervisor for a reference?
YES
NO
Company:
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Phone:
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Address:
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Supervisor:
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Job Title:
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Starting Salary:
$Click or tap here to enter text.
Ending Salary:
$Click or tap here to enter text.
Responsibilities:
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From:
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To:
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Reason for Leaving:
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May we contact your previous supervisor for a reference?
YES
NO
Company:
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Phone:
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Address:
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Supervisor:
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Job Title:
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Starting Salary:
$Click or tap here to enter text.
Ending Salary:
$Click or tap here to enter text.
Responsibilities:
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From:
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To:
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Reason for Leaving:
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May we contact your previous supervisor for a reference?
YES
NO
Military Service
Branch:
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From:
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To:
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Rank at Discharge:
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Type of Discharge:
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If other than honorable, explain:
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Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature:
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Date:
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Sunlight Senior Living does not discriminate in hiring or employment on the basis of race, color, religion, national origin, age, sex, disability, sexual orientation, Vietnam era military service, or any other basis on which discrimination is prohibited by Federal, State or local laws. No question on this application is intended to secure information to be used for such discrimination.