433 South Kinzer Avenue • New Holland, PA 17557
Phone: 717.355.6000 • Fax: 717.355.6277
www.gardenspotvillage.org

Application for Employment

Please complete this application in pen or type





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General Information











All applicants are required, as a condition of employment, to have a criminal history report performed. Conviction of one or more of the crimes listed in the Older Adult Protective Services Act may result in a denial of employment







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Education and Training
School Name Diploma Yes / No Degree Yes / No
High School
College
College
Tech School
Other



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Referred By

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EMPLOYMENT HISTORY Employment: List present or last employer first



















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Other Information MILITARY EXPERIENCE:



PERSONAL REFERENCES:
Name (No Relatives) Address / Email Address / Telephone Number Occupation
1.
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PERSON TO BE NOTIFIED IN CASE OF EMERGENCY:


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Final Step
Garden Spot Village is an equal opportunity employer and, in conformity with applicable laws, does not discriminate with regard to race, color, creed, national origin, ancestry, age, sex, handicap, disability, veteran status, or other status protected by law.

Please Note: Garden Spot Village is a Non-Smoking Campus.

READ CAREFULLY AND SIGN
I certify that facts given herein are true and complete to the best of my knowledge. I understand that any omission or false statements on this application or interviews shall be considered sufficient cause for rejection of my application or dismissal of my employment. I authorize and request the release of reference information from persons, employers, and /or school contacts by Garden Spot Village including investigation of all statements contained in this application as may be necessary in arriving at an employment decision. Garden Spot Village requires and employment shall be contingent upon passing a medical examination of the applicant selected for possible employment. Failure to submit to the physical examination will result in denial of employment. I understand that I am required to abide by all the rules and regulations of Garden Spot Village. I understand that no provision of the application, interviews, and/or other Garden Spot Village policies are intended to create an employment contract between Garden Spot Village and myself for either employment or the providing of any benefit. If an employment relationship is established, I understand that I have the right to terminate my employment at anytime and that Garden Spot Village retains a similar right.

I fully understand the terms and conditions of this document and agree to them in full.