Arbutus Park Retirement Community
Application For Employment

Arbutus Park Manor is an equal opportunity employer dedicated to a policy of non-discrimination in all areas of employment. In accordance with this policy all qualified applicants for employment will be considered without regard to race, color, creed, religion, sex, national origin, age, or the presence of a non-job related medical condition or handicap.

Equal Opportunity Employer

 

I General Information
Date Position applied for
Name Last First Middle

Maiden

Present Address Current Phone
Are you legally eligible for employment in the United States? Yes No
(Proof of U.S. Citizenship or Immigration Status will be required upon employment)
Have you been employed here before? Yes No Dates
Type of work desired Full-Time Part-Time Date Available
Are you related to anyone working here? Yes
If yes, state name and relationship
Are you age 18 or older? Yes No
Have you ever been convicted of a felony? Yes No
If yes, describe in full, including date(s)
II Work Experience
Beginning with your present or most recent employer, please list the requested information including military experience. Explain any gaps in employment in the comment section below.
Employer Dates of Employment

Address
Starting Hourly Rate / Salary     Ending Hourly Rate / Salary
Job Title Supervisor
Employer Dates of Employment

Address
Starting Hourly Rate / Salary     Ending Hourly Rate / Salary

Job Title Supervisor

Employer Dates of Employment

Address
Starting Hourly Rate / Salary     Ending Hourly Rate / Salary
Job Title Supervisor
Employer Dates of Employment

Address
Starting Hourly Rate / Salary     Ending Hourly Rate / Salary
Job Title Supervisor
Comments

III. EDUCATION
Name of Last High School Attended City and State


Name of College (s)Attended

No.of Years

Completed

 Degree

GPA /Class Rank

 Major

 

Minor

 
List Current job related Licenses or Certificates

What other education or training have you had? Describe the type of Training, the source and the dates?
Do you have a valid Pennsylvania Driver's License? Yes
What job skills do you posses?

IV. REFERENCES

Please list below three employment references whom we may contact for the ourpose o obtaing information relating to your current /previos employment, (or education or ppersonal references, if not previously employed)
Name / Position Organization Address Phone Number

V. Applicant's Certification

PLEASE READ CAREFULLY BEFORE SUBMITTING. IF YOU HAVE ANY QUESTIONS REGARDING THE FOLLOWINF STATEMENTS, PLEASE CALL FOR ASSISTANCE AT 814-262-2151

I certify that, to the best of my knowledge and belief, the answers given by me to the foregoing questions and the statements made by me in this application are correct and complete. I understand that any false statements on this application may result in my rejection or dismissal. Arbutus Park Manor is authorized to communicate with all my former employers, school officals, and persons named as references. I hereby release all employers, schools, and indivduals from any liabilty for any damage whatsoever resulting from giving such information.

I unnderstand that employment, if granted, is dependent upon satisfactorily passing a pre - employment physical, and subsequent physicals or other examinations as Arbutus Park Manor or their regulator agencies may require.

I understand that employment, if granted, has a defined probationary period and that I may be dismissed at any time during that period for any reason at the discretion of Arbutus Park Manor.

If employed, I understand and agree that such employment may be terminated at any time and without liabilty to me for continuation of wages, salary, or employment related benefits.

Date

Social Security Number

Email Address

Confirm Email Address