Employment Application

To Apply

  • Please fill out the below job application.
  • Employees who have at least six months in their current positions may apply by contacting their current supervisor who will contact Human Resources.
  • Qualified candidates meeting the minimum requirements must also have the ability to speak, read, write and understand the English language. They must also be able to perform the essential job functions of the position with or without reasonable accommodations.
  • South Coast Post Acute strives to maintain a culturally competent work force and specifically attempts to recruit bilingual staff.
  • *Refer to H.R. Policy HR 015 “Applicant Referral Program”

Job Application

POSITION APPLYING FOR

PERSONAL INFORMATION

(If hired, proof of lawful right to work in the US will be required.)

ACADEMIC TRAINING

List Any Licenses, Certifications, or Professional Designations Earned

MILITARY

SKILLS

Check Any Of The Following Skills You Possess

ADDITIONAL INFORMATION

An affirmative answer to any of these questions may not necessarily disqualify you from consideration for employment.

(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.

EMPLOYMENT HISTORY

Please list all of your previous employers with the most recent employer first. You must provide this information even if your resume has been submitted. Please provide all information requested. You must indicate the reason for leaving your previous employers.
Present or most recent
Name & Title
From
To
Present or most recent
Name & Title
From
To
You may exclude any information that would reveal protected class status.

REFERENCES

List three professional/personal references. Please do not list any family members or relatives.

AFFIDAVIT

By signing this application, I hereby agree as follows:

I certify that all information provided in this employment and supplementary applications are true and complete. I agree to have any of the statements checked by the Company unless indicated to the contrary. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I am aware that a more detailed investigation concerning background and credit may also be conducted upon contingent offer. I also understand that employment is contingent upon satisfactory completion of reference checks and the provision of satisfactory proof of an applicant's identity and legal authority to work in the United States.

I understand that if I am extended an offer of employment, it may be conditioned upon my successfully passing a pre-employment alcohol and drug screening examination. I understand that my job offer or my continuing employment, If hired, is contingent upon my being physically, mentally and medically able, with or without reasonable accommodation, to successfully perform the essential functions of my job. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.

I understand that nothing in this application, conveyed during any interview, or subsequent employment creates a contract of employment between the Company or any subsidiary or affiliate and myself, nor guarantees employment for any definite period of time. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without cause or notice by either myself or the Company. I understand that the Company can change benefits, policies and conditions at any time.

I understand that any and all disputes. regarding my employment with the Company, including any disputes relating to the termination of my employment, are subject to the Alternative Dispute Resolution process, which includes final and binding arbitration. I also understand and agree, as a condition of employment, to submit any such disputes for resolution under that process, and I further agree to abide by and accept the decision of the arbitration panel as the final binding decision and resolution of any such disputes I may have.

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING. I have read, understand, and by my signature consent to these statements.

APPLICANT PLEASE SIGN AND DATE HERE

By typing your full name you are submitting a digital signature of the aforementioned certification agreement.
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