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PLEASE COMPLETE ALL SECTIONS OF THIS APPLICATION.
When you are finished, click "Submit" to apply for the job. Incomplete applications will not be considered for employment.

Employment Application
1. Position You Are Applying For.
  1. Activity Assistant I / Full Time 40 hrs. per week / Benefit Eligible
  2. Companion Aide / Caring Hands / Variable Shifts
  3. Cooks / Full Time / Variable Shifts
  4. Dietary Aides / PT & FT opportunities / Variable Shifts
  5. Dining Team Leaders / SFT & FT opportunities / Non-Exempt / Variable Shifts
  6. Driver / Per Diem - work as needed
  7. Groundskeeper / Full Time / 1st Shift
  8. Housekeeper / Full Time / 1st shift
  9. Laundry Aide / Full time / 1st shift
  10. LPN's Assisted Living / PT & FT opportunities / All Shifts
  11. LPN's Crown Center - 12 hr. shifts / Semi full time
  12. LPN's Crown Center Skilled Nursing / PT & FT opportunities / All Shifts
  13. MA-C (Medication Aide - Certified) for Assisted Living
  14. Maintenance Floor Installer Mechanic / FT opportunity / 1st shift
  15. Maintenance Mechanic II / FT opportunity
  16. Maintenance Renovation Painter Mechanic / FT opportunity / 1st shift
  17. RN Supervisor Crown Center Skilled Nursing / PT & FT opportunities / All Shifts
  18. Security Officer / Full Time & PRN opportunities available
  19. Server / Semi full time 32 hrs. per week / Benefit Eligible
  20. STNA Caring Hands Home Health / PT & FT opportunities / All Shifts
  21. STNA's / Assisted Living / PT & SFT opportunities / All Shifts
  22. STNA's / Crown Center Skilled Nursing / 12 hr. shifts
  23. STNA's / Crown Center Skilled Nursing / PT, SFT & Weekend Warrior opportunities / All Shifts
2. Upload Resume (Optional) We can accept DOCX, DOC, RTF, TXT, or PDF documents up to 500 KB.
Personal Information
1. Prefix
2. First Name *
3. Middle Name
4. Last Name *
5. Suffix
7. Address *
8. Address 2
9. City *
10. State *
11. Zip Code *
12. County
13. Email *
14. Home Phone *
15. Cell Phone
16. If you are under 18 years of age, can you furnish a work permit?
  1. Yes
  2. No
17. Have you worked for Laurel Lake before?
  1. Yes
  2. No
18. If yes, what was the position and dates of employment?
Employment Preferences
1. Employment Status
2. Desired Shift
3. Desired Hours Per Week
Education, Skills, Licenses
1. High School
  1. (HS) Name
  2. (HS) City
  3. (HS) State
  4. Highest Grade Completed
  5. Are you still attending?
    
    Yes
    
    No
2. College, Technical or Trade School
  1. (CO) Degree
  2. (CO) Date Recieved
  3. (CO) School Name
  4. (CO) State
  5. (CO) Country
  6. (CO) Major
  7. (CO) Minor
  8. (CO) GPA
  9. (CO) Additional Information Use this space to tell us about any awards, academic honors or special achievements.
3. Licenses and Certifications
  1. (LI) License/Certification
  2. (LI) Expiration Date
  3. (LI) Issued By
  4. (LI) Country
  5. (LI) State
  6. (LI) Issue Date
  7. (LI) License/Certification Number
4. Language Skills
  1. Language (other than English)
  2. (Lan) Choose All That Apply
    
    Native Speaker
    
    Able to Translate
    
    Certified Medical Interpretor
  3. (Lan) Indicate areas where you are proficient
    
    Speaking
    
    Reading
    
    Writing
Employment History And References
All applicants MUST fully complete this section in order for your application to be accepted. List your employers starting with the most current/recent, including self-employment. Please do not state "Refer to Resume."

If this is your first job, check the box below and proceed to the "Personal References" section. If you have had ONE previous employer, you must completely fill out the employment history information requested. For two or more previous jobs, you must completely fill out the information requested for each job.
1. Employment History
  1. This will be my first job
  2. Job Title
  3. (Emp) Start Date
  4. (EMP) Exit Date (if applicable)
  5. Employer Name
  6. Employer Address
  7. (EMP) City
  8. (EMP) State
  9. (EMP) Zip
  10. Employer Telephone
  11. (EMP) Comments Describe your job responsibilities and any achievements you'd like to share. Please indicate your reason for leaving.
  12. It's OK to contact this employer *
    
    Yes
    
    No
Personal References
If you have held a previous job, you must provide at least ONE reference from that employer in order to be considered for this position. If you have held two or more jobs, you must provide at least TWO references from current or previous employers. If this will be your first job, please provide at least three personal references. Applications without at least two references will be considered incomplete.
1. 1st Reference
  1. Reference Name *
  2. Reference Type *
  3. (REF) Employer
  4. (REF) Title
  5. (REF) Address *
  6. (REF) Address 2
  7. (REF) City *
  8. (REF) State *
  9. (REF) Zip *
  10. (REF) Telephone *
2. Other References
  1. (REF2) Reference Name *
  2. (REF2) Reference Type *
  3. (REF2) Employer
  4. (REF2) Title
  5. (REF2) Address *
  6. (REF2) Address 2
  7. (REF2) City *
  8. (REF2) State *
  9. (REF2) Zip *
  10. (REF2) Telephone *
Mandatory Questionnaire
1. Employment Questionnaire
  1. Are you legally eligible for employment in the United States? Proof of US citizenship or immigration status will be required at employment. *
    
    Yes
    
    No
  2. Have you ever been convicted of, been fined and/or sentenced for any criminal offense (misdemeanor or felony) or have you ever pleaded “guilty” or “no contest” to any criminal offense? *
    
    Yes
    
    No
  4. Please describe the conviction and the date that it occurred. If your record has been expunged or sealed, you are not required to disclose this information.
  5. Can you perform the essential functions of the position for which you are applying? *
    
    Yes
    
    No
  6. Have you ever been suspended, sanctioned, barred or otherwise restricted from participating in any private, federal or state health insurance program (for example, Medicare or Medicaid)? *
    
    Yes
    
    No
  7. If yes, have you been reinstated?
    
    Yes
    
    No
  8. Are you aware that Laurel Lake Retirement Community is a tobacco/ nicotine-free workplace and prohibits smoking or use of tobacco/nicotine products on its premises and on paid time? *
    
    Yes
    
    No
  9. Do you have any relatives currently working for Laurel Lake Retirement Community? *
    
    Yes
    
    No
2. Referral Information
  1. How did you learn of the job?
  2. If a current Laurel Lake employee referred you, what is their name?
Application Review

I certify that I have read and understand this entire application and that the answers and statements given by me are true and correct to the best of my knowledge. I understand that any inaccurate or omitted information on the facts called for in this application may result in rejection of my application, or, if hired, immediate termination of employment.

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and Laurel Lake. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or Laurel Lake, and that no promises or representations contrary to the foregoing are binding on Laurel Lake.

I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to Laurel Lake and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information.

I understand that this application remains current for only 30 days. At the end of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to fill out a new application.

Laurel Lake does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under federal, state or local law. Laurel Lake likewise does not tolerate harassment of any sort based on a person’s membership in a protected category. Harassment of our employees by managers, subordinates or any other person is strictly prohibited. Laurel Lake takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.
1. BY CHECKING THIS BOX I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS. *
  1. I Agree

Security Check

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