FILL IN THE FORM BELOW

"*" indicates required fields

Application for Employment

All applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical or mental disability, medical condition, military or veteran status, genetic information, marital status, ethnicity, citizenship or immigration status or any other protected classification, in accordance with applicable federal, state, and local laws. By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our customers and contributing to the financial success of the organization, its clients, and its employees. Equal access to programs, services, and employment is available to all qualified persons. Those applicants requiring accommodation to complete the application and/or interview process should contact a management representative. Please print.

Position(s)*

Date of Application*

Print Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Main Phone*

Alternate Phone Number*

Email*

Employment Experience

List the names of your present or previous employers in chronological order with present or most recent employer listed first. Be sure to account for all periods of time. If self-employed, give firm name and supply business references. Add additional page if necessary.

Name of Employer

Supervisor

May we contact?*

Yes

Address

Street Address

Dates Employed (Month/Year)

Job Title and Duties*

Reason for Leaving

Name of Employer

Supervisor

May we contact?*

Yes

Address

Street Address

Dates Employed (Month/Year)

Job Title and Duties*

Reason for Leaving

Name of Employer

Supervisor

May we contact?*

Yes

Address

Street Address

Dates Employed (Month/Year)

Job Title and Duties*

Reason for Leaving

Have you ever been involuntarily terminated or asked to resign from any job?

Yes

If yes, explain

Explain any gaps in your employment history

List any other experience

Education

Describe your educational background in the table provided below.

High School

Years Completed

Area of Study/Major

Specialized Training

Diploma/Degree

Yes

College/University

Years Completed

Area of Study/Major

Specialized Training

Diploma/Degree

Yes

Graduate/Professional School

Years Completed

Area of Study/Major

Specialized Training

Diploma/Degree

Yes

Trade School

Years Completed

Area of Study/Major

Specialized Training

Diploma/Degree

Yes

Other

Years Completed

Area of Study/Major

Specialized Training

Diploma/Degree

Yes

Business and Professional References

List three professional references of individuals who are not related to you:

Full Name

Relationship

Phone

References 2

Full Name

Relationship

Phone

Full Name

Relationship

Phone

Personal References

List three people who know you well:

Full Name

Relationship

Phone

Full Name

Relationship

Phone

Full Name

Relationship

Phone

General Information

Have you ever used another name?

Yes

If yes to either of the above, provide the additional information:

Is any additional information relative to name changes, use of an assumed name, or nickname necessary to enable a check on your work and educational record?

Yes

Name changes, use of an assumed name, or nickname necessary to enable a check on your work and educational record

Have you ever worked for this company before?.

Yes

If yes, give dates

Give Position

On what date are you available to begin work?

Are you available to work?

Full-time

Part-time

Shift Work

Temporary

Days and hours you are available to work:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

If hired, would you have a reliable means of transportation to and from work?

Yes

Can you travel if the position requires it?

Yes

Can you relocate if the position requires it?.

Yes

Are you at least 18 years old?

Yes

Note: If under 18, hire is subject to verification that you are of minimum legal age.

If hired, can you present evidence of your identity and legal right to work in this country?

Yes

Are you able to perform the essential job functions of the job for which you are applying with or without reasonable accommodation?

Yes

If no, please explain:

Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions.

Applicant Statement and Agreement

Read and initial each paragraph below. If there is anything that you do not understand, please ask.

I hereby authorize the Company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure.

If I am employed by the Company, I understand that I am required to comply with all rules and regulations of the Company.

If hired, I understand and agree that my employment with the Company is at-will, and that neither I, nor the Company is required to continue the employment relationship for any specific term. I further understand that the Company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.

I understand that safety of employees is extremely important to the Company and that the Company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.

I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable.

MY ELECTRONIC SIGNATURE INDICATES THAT I HAVE READ, UNDERSTAND, AND AGREED TO ALL OF THE ABOVE TERMS

Signature

Name (print):*

Date

CAPTCHA

Comments

This field is for validation purposes and should be left unchanged.

We can solve any problem that may arise!

Get in touch with us today for the best and most reliable service!

Call our Office at 239-472-1101, or email us sancaphomeservices@yahoo.com

Book An Appointment

Call Us

CAREERS

FILL IN THE FORM BELOW

Application for Employment

Employment Experience

Education

Business and Professional References

Personal References

General Information

Days and hours you are available to work:

Applicant Statement and Agreement

MY ELECTRONIC SIGNATURE INDICATES THAT I HAVE READ, UNDERSTAND, AND AGREED TO ALL OF THE ABOVE TERMS

We can solve any problem that may arise!

Get in touch with us today for the best and most reliable service!