Application for Employment Step 1 of 5 20% This is a multi-page form. You must complete each page before moving on to the next page. If you unable to complete the entire form in one session, you may click on the "Save and Continue Later" link (below, next to the green button) at the base of the form page. You will be emailed a link that will allow you to come back to form where you left off to continue submission. Date of Application* MM slash DD slash YYYY Position(s) Applied For* Your InformationName* First Middle Last Address* Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Driver's License No.* State Issued* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Employment InformationType of Employment Desired* Full Time Part Time Indicated Days of Week Available* Select All Sun Mon Tue Wed Thu Fri Sat Approximate # of Hours per Week Available*Check all that apply* Regular Temporary Can you perform the essential functions of the job for which you are apply?* Yes No Date Available for Work* MM slash DD slash YYYY Have you ever been employed here before?* Yes No If Yes, please list position(s) held and dates of previous employment*Position(s) HeldDates of Employment How did you hear about this position?*Do you wish to claim veterans' preference?* Yes No If Yes, DD-214 (separation papers) must be attached. If you are a disabled veteran, attach current VA disability certification with DD-214Allowed file types for upload are: pdf, doc, docx, or jpg. Please ensure file sizes are under 2MB each. Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, Max. file size: 50 MB. Are you legally authorized to work in the U.S.?*Proof of legal authorization to work in the U.S. will be required upon employment. Yes No Have you been convicted of a criminal offense?*Such conviction may be relevant if job-related, but does not automatically bar you from employment. Yes No If Yes, Please explain.*Are you 18 years of age or older?* Yes No Are you currently employed?* Yes No If yes, may we contact your present employer?* Yes No Current EmployerCurrent Employer Name* Current Employment From* MM slash DD slash YYYY Current Employment To* MM slash DD slash YYYY Current Employer Address* Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current Employer Phone*Type of Business* Your Position Title* Why are you considering leaving?* Immediate Supervisor's Name First Last Supervisor's Title* Beginning Salary*Enter in full number format,i.e., $20,000, etc.Current Salary*Enter in full number format,i.e., $20,000, etc.Number of Employees You Supervised*Average Hours Worked per Week* 1-10 11-20 21-30 31+ Description of Position Duties* Have you been employed prior to current situation?* Yes No Most Recent EmployerEmployer Name* Employment From* MM slash DD slash YYYY Employment To* MM slash DD slash YYYY Employer Address* Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer Phone*Type of Business* Your Position Title* Why did you leave?* Immediate Supervisor's Name First Last Supervisor's Title* Beginning Salary*Enter in full number format,i.e., $20,000, etc.Last Salary*Enter in full number format,i.e., $20,000, etc.Number of Employees You Supervised*Average Hours Worked per Week* 1-10 11-20 21-30 31+ Description of Position Duties*Add another employer?* Yes No Previous EmployerEmployer Name Employment From MM slash DD slash YYYY Employment To MM slash DD slash YYYY Employer Address Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer PhoneType of Business Your Position Title Why did you leave? Immediate Supervisor's Name First Last Supervisor's Title Beginning SalaryEnter in full number format,i.e., $20,000, etc.Last SalaryEnter in full number format,i.e., $20,000, etc.Number of Employees You SupervisedAverage Hours Worked per Week 1-10 11-20 21-30 31+ Description of Position DutiesAdd another employer?* Yes No Previous EmployerEmployer Name Employment From MM slash DD slash YYYY Employment To MM slash DD slash YYYY Employer Address Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer PhoneType of Business Your Position Title Why did you leave? Immediate Supervisor's Name First Last Supervisor's Title Beginning SalaryEnter in full number format,i.e., $20,000, etc.Last SalaryEnter in full number format,i.e., $20,000, etc.Number of Employees You SupervisedAverage Hours Worked per Week 1-10 11-20 21-30 31+ Description of Position Duties Education and TrainingDo you possess a high school diploma or GED?* Yes No Indicate the last year of education completed.For high school diploma or GED circle “12.” 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 plus List formal education beginning with the most recent. Include high school, college, vocational or business school, apprenticeship, military training, etc. Most Recent Formal EducationName of School Address of School Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Type of Credit(semester, quarter, CEUs, etc.) Total Credit HoursMajor(s) or Course Minor(s) Did you graduate? Yes No Type of Degree Name of School Address of School Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Type of Credit(semester, quarter, CEUs, etc.) Total Credit HoursMajor(s) or Course Minor(s) Did you graduate? Yes No Type of Degree Other Educational ExperiencesUse this space to identify any other educational experiences you have had which are pertinent to this position. Include workshops, seminars, military or vocational training etc. which are not listed above. Indicate time involved (hours per week, number of weeks, number of credits, etc.) Other Skills and/or QualificationsSummarize special skills and qualifications, professional licenses or certifications that may qualify you for the position for which you are applying. Attach any certifications, licenses, etc. ReferencesReferences*References are required, please list 3.NamePhoneYears Known Verification and At-Will Employment I hereby certify that this application is complete to the best of my knowledge for the periods of employment listed and all information given is true and contains no misrepresentation. I am aware that all statements submitted on this application are subject to investigation and verification. I understand that any withholding of information, misrepresentation or falsification of statements on this application could result in rejection for employment, or if employed, termination from Sandstone Senior Living (SSL) at that time. I also understand nothing in this application or in granting of an interview is intended to create an employment contract. I have received no promise regarding employment and I understand no such promise or guarantee is binding on Sandstone Senior Living. If an employment relationship is established it is referred to as “employment at will.” This means that your relationship can be terminated at any time for any reason, with or without cause or notice by you or Sandstone Senior Living. No representative of SSL has authority to enter into any agreement contrary to the foregoing “employment at will” relationship. You understand that your employment is “at will” and that you acknowledge no oral or written statements or representation regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Administrator, Vice President or President.Verification and At-Will Employment Consent* I hereby certify that this application is complete to the best of my knowledge for the periods of employment listed and all information given is true and contains no misrepresentation.* Authorization and Release of Information In order for Sandstone Senior Living to access and verify my work history, I authorize any name mentioned as a reference on my application to release work related information to Sandstone Senior Living. A photocopy of this Authorization and Release may be treated as if it was an original. The original is maintained in the Human Resources Department and will be available upon request. I have carefully read and understand this Authorization and Release and have voluntarily agreed to its terms in order to assist SSL in its goal of engaging honest, trustworthy, reliable, capable, and nonviolent employees and volunteers. I further understand that all information and documents acquired by SSL will be maintained as confidential by the HR Department and they will not release such information to me, except as may be required by law.Authorization and Release of Information* I authorize any name mentioned as a reference on my application to release work related information to Sandstone Senior Living.*Signature*By typing in my name, I hereby sign this application. American with Disabilities Act: Sandstone Senior Living fully subscribes to the provisions of the Americans with Disabilities Act and will attempt in its employment process to make any reasonable accommodations necessary to assist qualified persons with disabilities. Equal Employment Opportunity: It is the policy of Sandstone Senior Living to provide equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, sexual orientation, national origin, creed, ancestry, pregnancy, age, genetic information, or disability in employment or the provisions of services, or any other basis prohibited by state or federal laws. NameThis field is for validation purposes and should be left unchanged.
