Online Job Application | St. Leonard - A Senior Living Community

Welcome to the online job application. This application consists of four sections (Personal Information, Education, Skills and Experience, Acknowledgments) Please complete each section of the application to the best of your ability. To open a section click on the title and it will expand.

PERSONAL INFORMATION
Name*
FirstLast
Social Security Number
Address*
Street AddressCityStateZip Code
Phone Number*
Additional Phone Number
Apply For - Title*
E-Mail Address
Do you have experience at this position?
- Yes
- No
If yes, how many years?
Have you ever worked at St. Leonard?
- Yes
- No
What was your name when you worked at St. Leonard?
Where did you work at St. Leonard?
When did you work at St. Leonard?
How did you learn of this vacancy?
- Current Employee
- Friend
- Relative
- Posting Board
- Website
- Job Fair / Conventions
- Job Line
- Advertisement
- Other
From which employee did you hear of the opening?
In which advertisement did you hear of the opening?
Other, please specify
Name of relatives in our employ
Date available for work
Salary or rate of pay expected
Per
Available to work
- Full Time
- Part Time
- PRN / Casual
Shift
- Days
- Evenings
- Nights
- Rotating
Have you ever been convicted of any misdemeanor or felony (this includes without limitation, pleading guilty, pleading no contest, or having a finding of guilty)? (Conviction is not an automatic bar to volunteer placement. Each case is reviewed on an individual basis.)
- Yes
- No
If yes, Please list:
Name(s) at the time
Date(s)
Location(s) - city, state
Type of Offense(s)
Have you ever applied at St. Leonard?
- Yes
- No
What position did you apply as?
When did you apply?
EDUCATION
High School
Name
Address
Street AddressCityStateZip Code
Highest Year Completed
Name while attending
Did you graduate?
- Yes
- No
GED
- Yes
- No
Presently Enrolled
- Yes
- No
Major
Technical School
Name
Address
Street AddressCityStateZip Code
Highest Year Completed
Name while attending
Did you graduate?
- Yes
- No
Presently Enrolled?
- Yes
- No
Major
College
Name
Address
Street AddressCityStateZip Code
Highest Year Completed
Name while attending
Did you graduate?
- Yes
- No
Presently enrolled?
- Yes
- No
Major
Graduate School
Name
Address
Street AddressCityStateZip Code
Highest Year Completed
Name while attending
Did you graduate?
- Yes
- No
Presently enrolled?
- Yes
- No
Major
PROFESSIONAL LICENSE AND / OR CERTIFICATES
Are you currently:
- Accredited
- Certified
- Licensed
- Registered
If you are accredited, certified, licensed or regisred, please list the type, the state of issuance, expiration dates and numbers
Are you eligible for:
- Accreditation
- Certification
- Temporary Permit
- Licensure
- Registration
If an examination is required, what date are you scheduled to take the exam?
Has your license ever been revoked, suspended or been subject to any disciplinary action?
- Yes
- No
If yes, please list: Name(s) at the time, Date(s), Location(s), Type of Offense(s), and Employer(s) at the time
SPECIAL SKILLS
Special skills you feel may be applicable
Software applications in which you are proficient
Residential Care Experience
Areas of Specialization
EMPLOYMENT RECORD

Start with your present or most recent employer and list your last three employers regardless of the type of work performed or length of employment. Be sure to answer all questions.
May we contact your current employer for references at the present time?
- Yes
- No
Employer 1

Employer 2

Employer 3
Employer
Employer's Phone
Supervisor's Name
Employment Start Date
Employment End Date
Employer's Address
Street AddressCityStateZip Code
Final Salary
Name while employed, if different than current name
Job Titles & Duties
- Full Time
- Part Time
- PRN / Casual Number of Hours
Reason for Leaving
Employer
Employer's Phone
Supervisor's Name
Employment Start Date
Employment End Date
Employer's Address
Street AddressCityStateZip Code
Final Salary
Name while employed, if different from current name
Job Titles & Duties
- Full Time
- Part Time
- PRN / Casual Number of Hours
Reason for Leaving
Employer
Employer's Phone
Supervisor's Name
Employment Start Date
Employment End Date
Employer's Address
Street AddressCityStateZip Code
Final Salary
Name while employed, if different from current name
Job Titles & Duties
- Full Time
- Part Time
- PRN / Casual Number of hours
Reason for Leaving
PERIODS OF UNEMPLOYMENT
Please account for any gaps in your employment history
REFERENCES

Please list professional references only, i.e. former supervisors, instructors, or professional associates.
Name
Occupation
Address
Street AddressCityStateZip Code
Phone
Name
Occupation
Address
Street AddressCityStateZip Code
Phone
Name
Occupation
Address
Street AddressCityStateZip Code
Phone
APPLICANT ACKNOWLEDGMENTS
1. I hereby certify that all responses set forth during my employment application process are true, correct, and complete. I understand and agree that any falsification, misrepresentation, or omission either on the employment application form or in my responses to questions asked during the interviewing or examination process may disqualify me from further consideration for employment, or if employed by St. Leonard will subject me to immediate termination, whenever the falsification or omission is discovered. In this regard, when an item is left blank on the employment application, it is because there is no information within its scope.
2. I understand that a drug and / or alcohol screen may be required before and during my employment. In addition, I authorize a medical examination, including a drug and / or alcohol screen, by an examiner selected by St. Leonard if I am made a contingent offer of employment. Such tests will be at St. Leonard's cost. I release and agree to indemnify St. Leonard, its affiliates, its authorized agents, and its employees, and all other persons, companies, and other entities from any and all liability arising out of any medical examination or drug / alcohol screen, disclosure and / or reporting of results or for the taking of any action based on the results of any medical examination or drug / alcohol screen.
3. I certify that I am a citizen of the United States, or if not, I can provide required documentation permitting me to work in the United States.
4. I understand and agree if I am employed by St. Leonard, my employment is at will so that I may terminate my employment at any time and for any or no reason. Likewise, St. Leonard can terminate my employment at any time and for any or no reason. I also understand and agree that nothing contained in St. Leonard's employment application or in the granting or conduction of an interview or anything set forth in any oral or written statement, communication, or policy now or in the future constitutes or creates or is intended to constitute or create a contract or promise between me and St. Leonard for employment, hours of work, or for the providing of benefits. Moreover, I acknowledge that St. Leonard reserves the right to modify, revoke, suspend, terminate or change any or all of its plans, policies, and procedures at any time, without prior notice. No promises or guarantees regarding employment, hours of work, or for the providing of benefits have been made to me and I understand and agree that no such promise or guarantee is binding on St. Leonard unless they are express promises, made in writing, and signed by the Executive Director of St. Leonard.
*
- I Agree
RELEASE AUTHORIZATION

My acknowledgement authorizes St. Leonard or its affiliates, or agents to conduct a thorough investigation of all statements, written and oral made by me during the employment application process, including without limitation, information concerning my character or employment positions, law enforcement record, and education background. I hereby authorize all persons, companies or other entities connected with any such information request, including without limitation, prior employers and law enforcement agencies to provide any and all information they may have regarding me or my employment. I release and agree to indemnify St. Leonard, its authorized agents, and its employees, and all other persons, companies, and other entities from any and all liability arising out of such investigation, including without limitation any liability for furnishing information or for taking any action based on the information provided.
*
- I Agree