TLAB-APP-1 (Revised 15 May 2021) | PART 4 OF 5

BETHANY

THE LODGE AT BETHANY

THE COTTAGES AT BETHANY

________________________________

APPLICATION FOR EMPLOYMENT (Cont)

First name

Last name

State the number of times you were absent from work during the past 12 months (unrelated to a serious health condition or disability):

State how many times you were disciplined at work during the past five (5) years and the reasons for each:

State how many times you have been discharged or asked to resign during the past ten (10) years and the reasons for each:

Skills & Qualifications

Summarize any special training, skills, licenses, and/or certificates that may assist you in performing the position for which you are applying.

Computer Skills (Check appropriate boxes. Include software titles and the number of years of experience in the space provided below this list.)

Please list software titles and the number of years of experience in the space provided:

Educational Background

Starting with your most recent school attended, provide the following information.

School 1

Number of years attended

GPA/Class Rank

Major/Minor

School 2

Number of years attended

GPA/Class Rank

Major/Minor

School 3

Number of years attended

GPA/Class Rank

Major/Minor

References

PROFESSIONAL ONLY NO FRIENDS OR FAMILY

List name and telephone number of three (3) business/ work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references that are not related to you.

Reference 1

Title

Reference 1: Phone

Reference 1: Email

How long have you known this person?

How do you know this person?

Reference 2

Title

Reference 2: Phone

Reference 2: Email

How long have you known this person?

How do you know this person?

Reference 3

Title

Reference 3: Phone

Reference 3: Email

How long have you known this person?

How do you know this person?

Please click "Submit" before you proceed with "Continue Application." Thank you!

CONTINUE APPLICATION