The Palms of Sebring

Application for Employment
Applicants will be considered without discrimination because of race, religion, color, sex, age, national origin, marital status, handicap or veteran status.
Position applied for: *

Contact Information
First Name: *
Last Name: *
Telephone Number: *
Present Address: *
City *
State *
Zip code: *
E-mail: *

Employment Information
Are you legally eligible for employment in the USA?	Yes No
Are you 18 years of age or older?*	Yes No
If no, how old are you?
Type of Employment:	Full-time Part-time
Pay Expected:	per hour per year
On what shift are you seeking work?
Were you ever employed by us previously?	Yes No
If yes, when?
When will you be available to begin work?
Are you on lay-off subject to recall elsewhere?
Are you able and willing to perform job related functions?	Yes No
If no, please explain.
How many days were you absent from work during the past year?
Have you ever been convicted of a crime?*	Yes No
If yes, state the nature of the offense and the date the offense took place.
(Conviction of a crime will not necessarily be a bar to employment. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account.)
List your specific job skills or work experience which you feel qualifies you for the job for which you are applying.
If a license is required for the position applied for, state license type and number.

Educational Background
Elementary School
School Name
School Location
Years Completed
Did you graduate?	Yes No
High School
School Name
School Location
Years Completed
Did you graduate?	Yes No
Business, Technical or Trade School
School Name
School Location
Course of Study
Years Completed
Degree Completed
College
School Name
School Location
Course of Study
Years Completed
Degree Completed
College / Other
School Name
School Location
Course of Study
Years Completed
Degree Completed

Additional information about your educational background

Employment History
Employer 1 (Most Recent)
Name*
Address*
Phone*
Supervisor's Name*
Dates Employed* (mm/yy to mm/yr)
Starting Salary	$
Ending Salary	$
Position and Duties
Reason for Leaving
Employer 2
Name
Address
Phone
Supervisor's Name
Dates Employed (mm/yy to mm/yr)
Starting Salary	$
Ending Salary	$
Position and Duties
Reason for Leaving
Employer 3
Name
Address
Phone
Supervisor's Name
Dates Employed (mm/yy to mm/yr)
Starting Salary	$
Ending Salary	$
Position and Duties
Reason for Leaving
Employer 4
Name
Address
Phone
Supervisor's Name
Dates Employed (mm/yy to mm/yr)
Starting Salary	$
Ending Salary	$
Position and Duties
Reason for Leaving
Employer 5
Name
Address
Phone
Supervisor's Name
Dates Employed (mm/yy to mm/yr)
Starting Salary	$
Ending Salary	$
Position and Duties
Reason for Leaving

Contract
The facts set forth in my application are true and complete. I authorize The Palms of Sebring to investigate all statements contained in this application and hereby authorize my former employers to furnish all information pertaining to my work record. I hereby release my former employers from all liability on account of furnishing such information to The Palms of Sebring. I understand that if employed, false statements, omissions or misleading statements on this application shall be considered sufficient cause for dismissal and I agree that The Palms of Sebring shall not be held liable in any respect if my employment is terminated because of such omissions, or false or misleading statements. The Palms of Sebring is hereby authorized to investigate my employment history, including the contacting of the employers listed above. If there is/are a particular employer/s you do not wish us to contact, please indicate which one and why.

I understand and agree that if employed, I will be subject to a 90 day probationary period. I also understand that if employed, my employment will be for no definite period and may be terminated by either The Palms of Sebring or myself at any time without previous notice and neither any written or oral statement by any managerial or supervisory official of The Palms of Sebring shall be construed to establish any contractual relationship between The Palms of Sebring (including any related company, parent or successor company) and myself.
Name (Digital Signature)*
Confirm and Agree*

Work with us.

Application for Employment