Experienced Eligibility Coordinator and Reliable Team Player

Patrick Laurita’s Employment Application

Application Date: 5/5/2024

Job Title: Eligibility Coordinator

Job Location: Daytona Beach

Personal Information

First Name: Patrick

Last Name: Laurita

Email: *******.*******@********.***

Contact Information

Country: United States

Current Address

Address: 931 N. State Road 434

Address #2: n/a

City: Altamonte Springs

Zip/Postal Code: 32714

Country: United States

State: FL

Contact Information

Cell Phone: 321-***-****

Home Phone: n/a

General Information

Are you 18 years of age or older? Yes

If no, can you furnish a work permit? Yes

Work Authorization: I am authorized to work in this country for any employer. Will you now or in the future require sponsorship for employment VISA status? No Have you previously filled out an application at this company? No If yes, please give date(s) and position(s): N/A

Have you ever worked for this company before? No

If yes, please give date(s) and position: N/A

How did you hear about this opportunity? Indeed

If "Employee Referral" please give employee name: N/A Are you related to any person currently employed at this company? : No If yes, please explain: N/A

Are you applying for: Full Time

Desired Compensation: 40,000

Available Start Date: 05/06/2024

Employment History

Please provide the following requested information regarding your employment history: Include military service assignments and volunteer activities. You may exclude organization names that include race, color, religion, gender, national origin, ancestry, age, disability or other protected status. Current or Most Recent Employer

Are you currently employed? No

Company Name: n/a

City and State: n/a

Title: n/a

From (MM/YY): n/a

To (MM/YY): n/a

Reason for Leaving: Resigned

Explanation: n/a

Rate of Pay: n/a

Direct Supervisor: n/a

Company Phone: n/a

OK to contact? n/a

Responsibilities and Duties: n/a

2nd Previous Employer

Company Name: n/a

City and State: n/a

Title: n/a

From (MM/YY): n/a

To (MM/YY): n/a

Reason for Leaving: n/a

Explanation: n/a

Rate of Pay: n/a

Direct Supervisor: n/a

Company Phone: n/a

OK to contact? n/a

Responsibilities and Duties: n/a

3rd Previous Employer

Company Name: n/a

City and State: n/a

Title: n/a

From (MM/YY): n/a

To (MM/YY): n/a

Reason for Leaving: n/a

Explanation: n/a

Rate of Pay: n/a

Direct Supervisor: n/a

Company Phone: n/a

OK to contact? n/a

Responsibilities and Duties: n/a

Education/Training

High School:

School Name: St. Mary's HS

City and State: Westfield, MA

Last Grade Completed: 12

Graduate? Yes

College or University:

Name of College/University: University of Phoenix

City and State: Orlando, FL

Course or Major: Healthcare Administration

Years Completed: 2

Degree: BSHA

Graduate? Yes

Graduate School:

Name of College/University: Webster University

City and State: Orlando, FL

Years Completed: 1

Degree: MHA

Graduate? No

Other

Name of School: n/a

City and State: n/a

Course or Major: n/a

Years Completed: n/a

Degree: n/a

Graduate? n/a

Please list any languages that you are proficient or fluent in: n/a List professional, trade, business, or civic activities and offices held. (You may exclude memberships that would reveal race, color, religion, gender, age, ancestry, national origin, disability, or other protected status): n/a References

Please list three professional references:

Reference Name: n/a

Company: n/a

Relationship: n/a

Phone: n/a

Email: n/a

Years Known: n/a

Reference Name: n/a

Company: n/a

Relationship: n/a

Phone: n/a

Email: n/a

Years Known: n/a

Reference Name: n/a

Company: n/a

Relationship: n/a

Phone: n/a

Email: n/a

Years Known: n/a

Accessibility

The Rehabilitation Act of 1973 prohibits discrimination on the basis of disability in programs conducted by Federal agencies, in programs receiving Federal financial assistance, in Federal employment, and in the employment practices of Federal contractors.

Section 504 states that "no qualified individual with a disability in the United States shall be excluded from, denied the benefits of, or be subjected to discrimination under" any program or activity that either receives Federal financial assistance or is conducted by any Executive agency. To see what the department is doing to assist the deaf and hard of hearing, please visit the departments Services for the Deaf and Hard of Hearing section. To read more about website accessibility read below.

Section 508 now establishes requirements for electronic and information technology developed, maintained, procured, or used by the Federal government. Section 508 requires Federal electronic and information technology to be accessible to people with disabilities, including employees and members of the public. In December 2000 the Federal Access Board issued final standards for electronic and information technology under Section 508 of the Rehabilitation Act. These were adopted and published in the Federal Registrar in April 2001 with enforcement to begin June 21, 2001.

While these standards currently apply to federal government, it is the direct responsibility of Florida state government agencies and their web designers and developers to become familiar with these accessibility guidelines and to apply these principles in designing and creating any official State of Florida web site. Community Partnership for Children welcomes your comments and suggestions for improving the accessibility of information on our website. If you use assistive technology and the format of any material on our website interferes with your ability to access information, we encourage you to notify us at 386-***-****. Applicant's Release

Submitting this application certifies that my answers to the forgoing questions are true and correct and that I understand that intentionally false information will result in refusal of employment or termination of employment if discovered after the date of hire.

I hereby authorize Community Partnership for Children (hereinafter referred to as CPC) to investigate all statements contained in this application and to interview the references and previous employers listed in this application. I authorize the references and previous employers listed to give CPC all facts, opinions and evaluations concerning my previous employment and any other information they may have, personal or otherwise, and release all such parties from any liability which may allegedly arise from furnishing such information to CPC, including, but not limited to, any liability for defamation or invasion of privacy. If I am offered employment, I understand that such an offer will be conditioned upon satisfactory results of a background investigation and/or agency medical examination or inquiry, including a drug screen test. If then employed, I understand that I will be required to serve a six (6) month (180 days) probationary period. I further understand that my employment and compensation can be terminated, with or without cause or notice, at any time, regardless of the successful completion of my probationary period, at the option of either CPC or myself understand that no supervisor or other representative of CPC other than the President of CPC has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. I further understand and voluntarily agree as a condition of employment or my continued employment, that I may be requested by CPC to submit to a urinalysis or other drug screen test and that my failure to take such test(s) when requested to do so or unsatisfactory test results will disqualify me from consideration for employment, or if I am then employed, may result in my immediate dismissal.

I certify that I have read, understand and agree with the above. By submitting this application, I affirm that I have read and agree to all of the disclosures and conditions included in the on-line application.

I have read and agree to this disclaimer: Yes

Applicant Signature: Patrick R Laurita

Date: 05/05/2024

By checking this box, you acknowledge and consent to terms of the privacy policy which applies to the applicant tracking service being offered by Paycor on behalf of Community Partnership For Children. The privacy policy offers an explanation of how and why your data will be collected, how it will be used and disclosed, how it will be retained and secured, and what legal rights are associated with that data (including the rights of access, correction, and deletion). The policy also describes legal and contractual limitations on these rights. The specific rights and obligations of individuals living and working in different areas may vary by jurisdiction. I have read and agree to this statement

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