Pinecrest Community | Pinecrest Pre-Employment Application

***This facility is an equal opportunity employer and will not discriminate or tolerate discrimination against any employee or applicant in any manner prohibited by law.
***All areas of this application, must be completed before it will be accepted as a valid application for employment at Pinecrest.
***An offer of employment is conditional upon the results of the following post hire tests: Physical Examination, Substance Abuse Screen and Criminal Background Check.
***At the time of interview you will be required to share your complete Social Security number.

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About Yourself

Date*

First Name*

Last Name*

Street Address*

City*

State*

Zip Code*

Email Address*

Telephone*

Birthdate (if under 18)

Position Desired*

Salary Desired*

Full or Part-Time*

Date You Can Start*

Shift Desired* 1st Shift
2nd Shift
3rd Shift

Are You Certified in Any Areas*

Please Specify*

Have You Ever Applied or Worked at Pinecrest?*

If Yes, When?*

Are You Presently Employed?*

If So, May We Inquire of Your Present Employer?*

Referred By*

Medical Review Policy

Pinecrest Community has a medical review policy, which includes a complete physical and drug screen following a conditional job offer. A start date would not be set until the medical review is completed and satisfactorily meets physical job requirements

Are You Eligible to Work in the United States?* Yes No

If Yes, What Type?*

Are you currently listed on The Office of Inspector General Federal Exclusion List?*

I understand that if I am offered a position there will be a criminal background check required, and filling my name into this field constitues a legal signature*

Education

High School

Name & Location of School*

No. Years Attended*

Did You Graduate?*

Subjects Studied*

College, Trade, Business Correspondence

Name & Location of School*

No. Years Attended*

Did You Graduate?*

Subjects Studied*

Former Employers (start with most recent)

If you have not had a past employer, please fill in the past employer boxes with the contact information of a teacher, pastor or someone you have done other work for.

Most Recent Employer

Date From*

Date To*

Name & Address of Employer*

Position Held, Duties and Salary*

Phone Number*

Reason for Leaving*

By checking this box, you give Pinecrest permission to inquire of this employer*

Employer 2

Date From*

Date To*

Name & Address of Employer*

Position Held, Duties and Salary*

Phone Number*

Reason for Leaving*

By checking this box, you give Pinecrest permission to inquire of this employer*

References: Two non - related persons that you have known at least 1 year

Reference 1

Name*

Address*

Phone Number*

Business*

Years Acquainted*

By checking this box, you give Pinecrest permission to inquire of this reference*

Reference 2

Name*

Address*

Phone Number*

Business*

Years Acquainted*

By checking this box, you give Pinecrest permission to inquire of this reference*

Authorization

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on the application can be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you."

Date*

Signature*

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Thank you

for submitting your application.

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