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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Email

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Date Available:

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Social Security No.:

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Desired Salary:

$Click or tap here to enter text.

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.

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