Employment Application

EMPLOYMENT APPLICATION
THE MANSION AT KEUKA LAKE

3456 RT 54A, KEUKA PARK NY 14478
All applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical/mental disability, medical condition, military/veteran status, genetic information, marital status, ethnicity, citizenship or immigration status, or any other protected classification, in accordance with applicable federal, state, and local laws. By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our customers and contributing to the financial success of the organization, its clients, and its employees. Equal access to programs, services, and employment is available to all qualified persons. Those applicants requiring an accommodation to complete the application and/or interview process should contact a management representative.
Position(s) applied for
Date of application

MonthDayYear
Date
Print full name

First NameLast Name
Street address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Main phone number
Format: (000) 000-0000.
Alt. phone number
Format: (000) 000-0000.
Email
example@example.com

Employment Experience
Please list the names of your present or previous employers in chronological order with present or most recent employer listed first. Be sure to account for all periods of time. If self-employed, give firm name and supply business references. Add an additional page if necessary.
Name of employer
Supervisor
May we contact?
Street Address
Phone Number
Format: (000) 000-0000.
Dates employed (month/year) From

MonthDayYear
Date
To

MonthDayYear
Date
Job title and duties
Reason for leaving
Name of employer
Supervisor
May we contact?
Street Address
Phone Number
Format: (000) 000-0000.
Dates employed (month/year) From

MonthDayYear
Date
To

MonthDayYear
Date
Job title and duties
Reason for leaving

Have you ever been involuntarily terminated or asked to resign from any job?
If yes, please explain.
Please explain any gaps in your employment history.
Please list any other experience, job-related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualifications for employment.
Education
Please describe your educational background in the table provided below.

Education Please describe your educational background in the table provided below.

Rows	School name	Diploma/ degree (Yes/No)	Area of study/ major	Specialized training, skills, or extracurricular activities
High school
College/ university
Graduate/ professional school
Trade school
Other

Applicant Statement and Agreement
Please read each paragraph below, check the box if you agree. If there is anything that you do not understand, please ask.

I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the company any and all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers, and all other persons, corporations, partnerships, and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure.If hired, I understand and agree that my employment with the company is at will and that neither I nor the company is required to continue the employment relationship for any specific term. I further understand that the company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.I understand that the safety of employees is extremely important to the company and that the company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
My signature attests to the fact that I have read, understand, and agree to all of the above terms.
Signature:
Name (print):
Date:

MonthDayYear
Date
Please verify that you are human
Should be Empty:

Rows	Name and title	Relationship	Phone number or email
1
2
3

Rows	Name and title	Relationship and years acquainted	Phone number or email
1
2
3

EMPLOYMENT APPLICATION

THE MANSION AT KEUKA LAKE

Employment Experience

Education

Business and Professional References

Personal References

General Information

Applicant Statement and Agreement