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Employment Application
(This company will make reasonable accomodations for handicapped individuals)
PRIOR WORK HISTORY
PERSONAL REFERENCES (Excluding former employers or relatives)
EDUCATION
 Years

 Years

 Years

If you are applying for a position that requires state or national registration or certification,
you must furnish us with current proof of certification or registration

Employement Application Certification

I certify that all of the information listed on this employment application is true and complete. I understand that any false, incomplete or misleading information given by me on this application is sufficient cause for rejection of this application. I also understand and agree that any false, incomplete, or misleading information discovered on this application any time after I am employed may result in dismissal. I agree that the St. Johns Welfare Federation shall not be held liable if my employment is terminated because of my omissions, or false or misleading statements.

I authorize the St. Johns Welfare Federation or its delegate to investigate all statements contained in this application, to interview the references and previous employers listed in this application, and to obtain a report from a consumer- reporting agency to be used for employment purposes in accordance with the Fair Credit Reporting Act. This includes all required State of Florida Agency for Health Care Administranion background checks.

I authorize the references and previous employers listed to give the St. Johns Welfare Federation all facts, opinions and evaluations concerning my previous employment and any other information they may have, personal or otherwise, and release all such parties form any liability which may allegedly arise fi'orn furnishing such information to the St. Johns Welfare Federation, including, but not Uniited to, any liability for defamation or invasion of privacy.

If offered employment, I understand that the offer will be conditioned upon satisfactory results from reference checks, Level I and Level II background investigation, drug screen, and verification of any information provided in this application. If employed, I understand that I will be required to serve a ninety (90) day probationary period. if I vacate the position or am discharged for cause at any time during the probationary period, I understand that the cost of the background checks and drug screen will be deducted from my final paycheck. I understand that my employment can be terminated, with or without cause or notice, at any time, regardless of the successful completion of my probationary period. at the option of either the St. Johns Welfare Federation or myself.


   
PRE-EMPLOYEMENT BACKGROUND REQUIREMENTS

The State of Florida and Agency for Healthcare Administration requires that both a Level I and Level II background screening be performed on each applicant. A Level II status of "eligible" is required for employment in healthcare facilities. The following information is necessary to obtain or register the applicant for the Level I and/or Level II


* A copy of your drivers license and Social Security card will need to be provided to us if an offer of employment is made and accepted.