5th Avenue between 50th/51st Streets New York, NY 10022
Telephone: +1 212-202-6626 Affix Recent
Passport
EMPLOYMENT APPLICATION FORM Photograph
Please answer all questions carefully in ink and in your own handwriting
DATE OF APPLICATION: Day Month Year
FIRST NAME: LAST NAME:
PHONE NUMBER: ( ) [Link] ( )
ADDRESS:
STREET/POST OFFICE BOX APT. CITY PROVINCE POSTAL CODE
POSITION APPLYING FOR:
ALTERNATIVE POSITION APPLIES FOR:
EMPLOYMENT STATUS: FULL TIME PART TIME TEMPORARY
PLEASE OUTLINE THE HOURS/SHIFTS YOU ARE AVAILABLE TO WORK:
NATIONALITY: DATE OF BIRTH? PASSPORT NUMBER
HAVE YOU APPLIED AT THIS PROPERTY PREVIOUSLY? IF YES, WHEN?
DO YOU WANT TO COME ALONE OR WITH FAMILY MEMBERS
DOYOUHAVEANYFRIENDORRELATIVE INUS? YES NO
IF YOU ARE TO BE SELECTED FOR THIS JOB CAN YOU BEAR THE VISA FEE WHICH IS $350 US DOLLAR:
YES NO
NOTE: CANDIDATES WHO ARE CAPABLE TO BEAR THEIR VISA FEE WHICH IS $350 US DOLLAR CAN ONLY APPLY
FOR THE JOB IT IS MANDATORY, THE VISA FEE HAS TO BE PAID BY YOU IN YOUR COUNTRY, WHICH IS
REFUNDABLE BY THE MANAGEMENT ONCE YOU JOIN.
EDUCATION:
Name of School City Province
Secondary School
College/University
Graduate or Technical Schools
Additional training, special achievements, certificates, honors, relevant to position applied for:
Special Skills:
Which languages, other than English, do you speak fluently?
EMPLOYMENT HISTORY
Please give most recent job first. Include summer & part-time work. Indicate if employed under another name.
1. Employer:
Address:
Telephone (w): Telephone (h):
Employed from: Day _Month Year to Day Month Year
Position: Full-Time Part-Time
Description of duties:
Name & Title of Supervisor:
Reason for leaving?
2. Employer:
Address:
Telephone (w): Telephone (h):
Employed from: Day _Month Year to Day Month Year
Position: Full-time Part-time
Description of duties:
Name & Title of Supervisor:
Reason for leaving?
3. Employer:
Address:
Telephone (w): Telephone (h):
Employed from: Day _Month Year to Day Month Year
Position: Full-time Part-time
Description of duties:
Name & Title of Supervisor:
Reason for leaving?
4. Employer:
Address:
Telephone (w): Telephone (h):
Employed from: Day _Month _Year to Day Month Year
Position: Full-time Part-time
Description of duties:
Name & Title of Supervisor:
Reason for leaving?
SELECT YOUR CAREER HERE
Medical Assistant Nursing Assistant Home Health Aide
Licensed Practical Nurse Physician Therapist
Registered Nurse Pharmacy Technician Diagnostic Medical
Sonographer
Telephone Attendant Reservation Supervisor Clinical Laboratory Technician
Dental Assistant Pharmacist Emergency Medical Technician
Radiologic Technologist Physical Therapist Dental Hygienist
Health Information Technician Clinical Laboratory Technologist Occupational Therapy Aide
Respiratory Therapist Speech Language Pathologist Family Practitioner
Dentist Nurse Practitioner Occupational Therapist
Phlebotomist Surgical Technologist Physician Assistant
Veterinary Technologist Psychiatric Aide Public Space Cleaner
Medical Transcriptionist Occupational Health and Safety Laboratory Animal Caretaker
Specialist
Massage Therapist Physical Therapy Assistant Dispensing Optician
Dietician Veterinarian Orderly
Cardiovascular Technologist Laundry Supervisor Surgeon
Medical Equipment Preparer Maintenance Engineer Nurse Anesthetist
Operations Manager Pediatrician Anesthesiologist
Front Desk Manager Room Service Manager Accounting Manager
Payroll Manager Receptionist Maintenance Manager
Magnetic Resonance Optometrist Chiropractor
Imaging Technologist
Psychiatrist Obstetrician House Keeping Manager
BUSINESS & PERSONAL REFERENCES
Name Occupation Address Telephone
PLEASE READ THE FOLLOWING AND SIGN YOUR NAME BELOW
I declare that the information contained in this application is correct to the best of my knowledge and
understand that any omission or incorrect information is just cause for the rejection of my application,
or dismissal in accordance with Company policy. I authorize the property, or its agents, to verify the
information provided and to obtain any other information relevant to this application. This information
may be obtained by telephone or in writing from educational institutions, my current and former
employers, financial institutions, personal information agents and my personal references. This consent
is valid during the consideration of my application for employment, and if I am hired for the duration
of my employment.
Signature Date:
THE INFORMATION THAT YOU HAVE SUPPLIED, AND ANY OTHER INFORMATION OBTAINED, WILL BE
USED SOLELY FOR THE ASSESSMENT OF YOUR APPLICATION FOR EMPLOYMENT.
