The St. Luke Family of Caring Job Application
Personal Info
- Name
- Street
- City
- State
- Zip
- Phone
- Work Permit
- Legal Right
- Alien Reg. #
- Criminal Offense No
- Criminal Offense Detail
Position Details
- Reviewed Job No
- Reviewed Job Detail
- Position Applied For
- Hours
- Attendance Requirements No
- Shift
- Date Available
- Applied Before No
- Applied Before Date
- Applied Before Name
- Applied Before When
- Supervisor
- Reason For Leaving
Education
- High School
- High School Years
- High School Graduated
- High School Relevant
- High School Major
- High School Degree
- High School Course
- College
- College Years
- College Graduated
- College Relevant
- College Major
- College Degree
- College Course
- Other
- Other Years
- Other Graduated
- Other Major
- Other Degree
- Other Course
References
List below the names of three (3) persons not related to you:
| Name | Relationship | Phone | Years Known |
|---|---|---|---|
| References |
Employers
Provide the following information, starting with your present or most recent employment
| Dates | Employer Name | Phone | Job Title | Address | Supervisor | Reason for Leaving | Duties |
|---|---|---|---|---|---|---|---|
| - | Employers |
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.
- Signature -