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Gardens Application Form

MaleFemale
American Indian or Alaskan NativeAsianBlack or African AmericanHispanic or LatinoCaucasianTwo or more races

PRE- EMPLOYMENT APPLICATION


Person to contact in case of emergency:

Full TimePart TimeReliefPer Diem
DayEveningsNights

Have you ever worked or applied at Mt. San Antonio Gardens before?

YesNo
YesNo

BACKGROUND DATA

YesNo
YesNo
YesNo
YesNo
YesNo

EMPLOYMENT IS CONTINGENT ON THE ABILITY TO PASS A PHYSICAL EXAMINATION AND A DRUG AND ALCOHOL SCREEN, PROVIDE ACCEPTABLE REFERENCES, AND SUBMIT PROOF OF IDENTITY AND LEGAL ABILITY TO WORK IN THE UNITED STATES.

Mt. San Antonio Gardens is an equal opportunity employer. It is our policy to recruit, hire and promote for all job classifications on the basis of merit, qualifications and competence. All employment decisions will be based on the individual's qualifications related to requirements of the positions being filled. Mt. San Antonio Gardens will hire only individuals who are legally able to work in the United States.

This section must be completed, even if supplemented by a resume. Beginning with the present, list all jobs during the past ten years. include military service and unemployment.

Dates of Employment Company Name and Address (*) Phone Number (*) Supervisor (*) Title and or Duties (*)
From (*) To (*)
Salary (*) Reason for Leaving (*)

Dates of Employment Company Name and Address Phone Number Supervisor Title and or Duties
From To
Salary Reason for Leaving

Dates of Employment Company Name and Address Phone Number Supervisor Title and or Duties
From To
Salary Reason for Leaving

PERSONAL REFERENCES: (DO NOT list employers or relatives. Provide all requested information for three references.)

Name (*) Address (*) Phone Number (*)

EDUCATIONAL RECORD:

Name City/State # of Years Completed Major Diploma or Degree
Last High School:
College/University:
Additional Education:

Adult Education or Special Vocational Training:


Professional Registry and/or License Number:

State: Expiration Date:
Foreign Languages : I read: I Speak: I Write:

UPLOAD RESUME AND COVER LETTER:


I understand any misrepresentation or material omission of information in this application or health service medical record will be cause for denial of employment or for dismissal if employed. I authorize all former employers, companies, agencies and persons contacted to release any and all information in their possession which has or may have bearing on my suitability for employment. I understand a physical examination which includes a drug and alcohol screen by Mt. San Antonio Gardens physician will be required prior to my employment. I agree to and understand the above statements. I hereby certify that all the information included on this application is true to and complete to the best of my knowledge. I understand that employment at Mt. San Antonio Gardens is at the mutual consent of employer and employee, and that the employment relationship can be terminated by either party. Mt. San Antonio Gardens is a non-smoking facility.

I Accept the above terms and submitting the application form.