Job Application

We appreciate your interest in The St. Luke Family of Caring. The St. Luke Family of Caring offers equal opportunities to all persons without regard to race, color, religion, age, sex, disability, national origin, ancestry, citizenship, military or veteran status, marital status, sexual orientation, domestic violence victim status, predisposing genetic characteristics or genetic information, or any other status protected by law.

Personal Information

If under 18 years of age, do you have a work permit?

If not a U.S. citizen, do you have the legal right to remain permanently and work in the U.S.?

Have you ever pled guilty or been convicted of a criminal offense (not including traffic violations)? *

Position Details

Have you reviewed the job description of the position for which you are applying? *

Part-time or Full-time? *

Are you able to meet the attendance requirements of the position? *

Shift you can work:

Have you ever applied to St. Luke, Bishop’s Commons or St. Francis before? *


High School Education

Did you graduate?

College Education

Did you graduate?


List below the names of three (3) persons not related to you:

Reference 1

Reference 2

Employment History

Provide the following information, starting with your present or most recent employment

Employer 1

Employer 2

Employer 3

May we contact your present employer at this time?

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Applicant's Statement

The above information is complete and true to the best of my knowledge. I understand that discovery of misrepresentation or omission of facts herein will be cause for immediate dismissal. I give the employer the right to contact and obtain information from all references, employers, and education institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information. I understand that any employment by this facility will be on a 90-day probationary basis. I understand that nothing in this application is to be considered a contract of employment, or a limitation on the Facility's right to terminate my employment at any time after I am hired.

My signature below indicates that I have read this paragraph and understand what it says.