Careers

APPLICATION FOR EMPLOYMENT

Facility Name: Lotus Assisted Living Facility INC

Address: 1477 SW Goodman Ave, Port Saint Lucie FL 34953

Please answer all questions. Resumes are not a substitute For A Completed Application.

I UNDERSTAND THAT NEITHER THIS APPLICATION NOR ANY COMMUNICATION BY A MANAGEMENT REPRESENTATIVE IS INTENDED TO CREATE OR DOES CREATE A CONTRACT OF EMPLOYMENT, OFFER, OR PROMISE OF EMPLOYMENT. I ACKNOWLEDGE THAT IF HIRED BY THE COMPANY, EMPLOYMENT IS ON AN AT-WILL BASIS. THIS MEANS THE COMPANY IS FREE TO TERMINATE MY EMPLOYMENT AT ANY TIME, WITH OR WITHOUT CAUSEOR ADVANCE NOTICE, IN ACCORDANCE WITH STATE LAW, AND ACCEPTANCE OF EMPLOYMENT IS NOT A CONTRACT OF EMPLOYMENT FOR ANY SPECIFIED TIME. SIMILARLY, I AM FREE TO TERMINATE MY EMPLOYMENT WITH THE COMPANY AT ANY TIME FOR ANY REASON. THIS AT-WILL PROVISION MAY BE MODIFIED OR WAIVED ONLY IN A WRITTEN AGREEMENT SIGNED BY AN AUTHORIZED REPRESENTATIVE OF THE COMPANY AND ME. I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE COMPANY, AND I UNDERSTAND THAT THE COMPANY HAS COMPLETE DISCRETION TO MODIFY SUCH RULES AND REGULATIONS AT ANY TIME, EXCEPT THAT IT WILL NOT MODIFY ITS POLICY OF EMPLOYMENT AT-WILL.

We are an equal opportunity employer. Applicants are considered for positions without regard to race, religion, sex, national origin, age, disability, or any other consideration made unlawful by applicable federal, state, or local laws.

Position Applied For

Social Security Number

Name

Phone Number

Address

City/State/Zip

Desired Salary

If under the age of 18, can you produce the necessary work certificate at the time of employment?

yes

Type of employment desired?

Full-time

Part-time

(Specify Hours)

Are you willing to work overtime?

Yes

Date on which you can start

Have you ever applied to this Company before?

Yes

If Yes, when did you apply?

where did you apply?

Within the past ten (10) years, have you been convicted of a felony? (Do not include convictions that were sealed, eradicated, erased, or expunged; convictions that resulted in referral to a diversion program; or marijuana-related convictions that are more than two (2) years old.)

Yes

If Yes, please explain so that individual circumstances can be considered.

Have you ever initiated an act of violence in the workplace?

Yes

If Yes, please explain so that individual circumstances can be considered. (A Yes answer will not necessarily disqualify you from employment).

List special technical skills that you feel qualify you for the job for which you are applying (i.e., computer programming/language, software, equipment operation, special tools or machines, etc.)

Education:School Name and Location, Course of Study, Graduate?, # of Years Completed, Degree/Major

Honors Received

WORK EXPERIENCE Start with your present or last place of employment. You may include any verifiable work performed on a volunteer basis, internships, or military service.

Name of Employer

Employer Address

Type of Business

Employer Phone

Date of Employment: From-To

Job Title:

Supervisor’s Name

May we contact?

Yes

Wages Start

Final

Reason for Leaving

Duties

References Please list the names of additional work-related references we may call. Individuals with no prior work experience may list school or volunteer related references.

#1. Name, Position, Company, Work Relationship (i.e., supervisor, co-worker), Telephone Number

#2.Name, Position, Company, Work Relationship (i.e., supervisor, co-worker), Telephone Number

#3. Name, Position, Company, Work Relationship (i.e., supervisor, co-worker), Telephone Number

Careers

APPLICATION FOR EMPLOYMENT

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