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Employment Opportunities

Application Form

Oyster Bay Manor is an Equal Opportunity Employer in accordance with all Federal and State laws. It is the policy of Senior Assisted Living Communities to provide equal employment opportunities for all qualified individuals with respect to employment, performance, evaluation, promotion, training, and all other related personnel activities without regard to Race, Religion, Sex, National Origin, Age, Disabilities as Defined by Law, Sexual Orientation, Marital Status, Political Affiliation, Citizenship and Alienage, Recovering or Recovered Substance Abusers, and person perceived to fall within a protected class. 

Last Name:
Middle Initial:
First Name:
Email:
Address:
City:
State:
ZIP Code:
Home Telephone:
Cellular Telephone:
Social Security #:
Postition Applying For:
    
       
   
Are you a U.S. Citzen:   
If No, do you have legal right to work in the United States?     
Employment Authorization Card / INS #:
   
Are you at least 18 years of age?   
   
How were you referred to us?
   
Do you have any physical, mental, or medical disabilities that could affect your ability to perform the essential functions of the job for which you are applying? Please note that Senior Assisted Living Communities subscribe to the ideals, intents, and policies of the Americans with Disabilities Act of 1990, and will make reasonable accommodations to those with a disability, providing that it does not impose an undue hardship on administering residents care.
     If Yes, Please Explain:
   

Have you ever been convicted of a crime other than a traffic violation? Please note that criminal convictions are not automatic bar to employment.

     If Yes, Please Explain:
   
RELATIVES EMPLOYED BY SENIOR ASSISTED LIVING COMMUNITIES
Name:   Relationship:
Name:   Relationship:
   
EDUCATION / TRAINING / CREDENTIALS
Name of Institution
Diploma / Degree /
Course of Study
Years
Attended
High School:
College:
Graduate School:
Trade School:
   
PROFESIONAL LICENSE(S)   /   CERTIFICATION(S)   /   REGISTRATION(S)
Name
Number
State(s) In
Which Valid
Expiration Date
   
EMPLOYMENT HISTORY
Most Recent Employer  
Employer:
Address:
Supervisor:
Position:
Start Date:
End Date:
Telephone:
Salary / Hourly Rate:
    
May we contact this employer:   
Reason for leaving:
   
Most Recent Employer  
Employer:
Address:
Supervisor:
Position:
Start Date:
End Date:
Telephone:
Salary / Hourly Rate:
    
May we contact this employer:   
Reason for leaving:
   
Most Recent Employer  
Employer:
Address:
Supervisor:
Position:
Start Date:
End Date:
Telephone:
Salary / Hourly Rate:
    
May we contact this employer:   
Reason for leaving:
   
Comments:
   
I certify that the information contained in this application is correct and complete to the best of my knowledge. I understand that any misleading or falsified statements or omission of facts may disqualify my application, or may be cause for immediate termination when discovered. In addition, I understand that any offer of employment is provisional until such time that complete and satisfactory reports are received pertaining to a Physical Exam, Mantoux/PPD, Background Check, Verification of Credentials, and satisfactory Employment References. I further understand that background checks and/or social security checks are part of the hiring process, and I hereby release Senior Residence Assisted Living Communities, its affiliated companies, associates, and agents from any liability from requesting such information.
   

150 South Street
Oyster Bay, NY 11771
Tel.: (516) 624-0600
Fax: (516) 624-2949

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