Careers Interested in working at The Lodge? Please fill out the form below. Employment Application Step 1 of 7 14% Applicant InformationFull Name Address Street Address City State / Province / Region ZIP / Postal Code PhoneEmail Date Available MM slash DD slash YYYY Social Security No Desired Salary Position Applied for Are you authorized to work in the U.S.? Yes No Have you ever worked for this company? Yes No Please explain Have you ever been convicted of Medicare fraud? Yes No Please explain Have you ever been convicted of a crime, including misdemeanors? Yes No Please explain Specify days you are available to work Monday Tuesday Wednesday Thursday Friday Saturday Sunday Specify times you are available to work Days Evenings Overnights Desired Employment Status Full Time Part Time How did you find out about this job opening? Web Page (identify) Newspaper/ Journal Ad (identify) Referral Job Service Other (please explain) Please explain EducationHigh School Address Did you graduate? Yes No Degree College Address From MM slash DD slash YYYY To MM slash DD slash YYYY Did you graduate? Yes No Degree Other Address From MM slash DD slash YYYY To MM slash DD slash YYYY Did you graduate? Yes No Degree Professional Licenses and/or CertificationsCertificate 1 Type, Origin or State Issued, Date Issued, NumberCertificate 2 Type, Origin or State Issued, Date Issued, NumberCertificate 3 Type, Origin or State Issued, Date Issued, Number Previous EmploymentCompany PhoneAddress Supervisor Job Title Starting SalaryEnding SalaryResponsibilities From MM slash DD slash YYYY To MM slash DD slash YYYY Reason for Leaving May we contact your previous supervisor for a reference? Yes No Company PhoneAddress Supervisor Job Title Starting SalaryEnding SalaryResponsibilities From MM slash DD slash YYYY To MM slash DD slash YYYY Reason for Leaving May we contact your previous supervisor for a reference? Yes No Company PhoneAddress Supervisor Job Title Starting SalaryEnding SalaryResponsibilities From MM slash DD slash YYYY To MM slash DD slash YYYY Reason for Leaving May we contact your previous supervisor for a reference? Yes No Please explain all periods of unemploymentIf your former employment references or education are under a name other than presented on the front of the application please indicate Last, First, M.I.Please list any additional information which will assist us in placing you ReferencesPlease list three professional references and one personal reference.Full Name Relationship Company PhoneAddress Full Name Relationship Company PhoneAddress Full Name Relationship Company PhoneAddress Full Name Relationship Company PhoneAddress Military ServiceBranch From MM slash DD slash YYYY To MM slash DD slash YYYY Rank at Discharge Type of Discharge If other than honorable, explain Are you aware of any limitation you may have which would limit your ability to perform the essential functions of the position(s) for which you are applying? Yes No Please explain what accommodations will you require Disclaimer and SignatureI voluntarily give The Lodge at Old Trail the right to make a thorough investigation of my past employment and activities. I agree to cooperate in such investigations and release from all liability or responsibility all persons, companies, or corporations supplying such information. I understand that for positions which require use of a company vehicle, a check of my driving record will be conducted. I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I consent to take the employment physical examination after I am given an offer or employment and such future physical examinations as may be required by The Lodge at Old Trail, which may include a drug test, at such time and places as The Lodge at Old Trail shall designate. I acknowledge that I may be required to take a drug test at any time during my employment with The Lodge at Old Trail. I understand that my employment is at will, and that either party is free to terminate the employment relationship at any time without cause. I understand that I will be required to follow the personnel policies and rules of The Lodge at Old Trail and those infractions may lead to dismissal. I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form. If employed, I will be required to complete Employment Verification Form (I-9), and show satisfactory evidence of identity and eligibility for employment in the USA.Signature Date MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
