An Equal Opportunity Employer

Education

Name of school/ trainiong attended

City/ State

Attended from/ to. If still attending, days/ times

Diploma or certificate received

Employment History

Professional References

Give the names of three persons, not related to you, whom you have known for at least one year

NOTICE:  New employees are required to produce verification of their legal right to work in the United States.  If you are offered employment, you will be required to produce sufficient documentation of your identity and right to work in the United States and to attest under penalty of perjury that the documents you have produced are genuine and relate to you.

This Company’s policy is to fill every position without regard to race, color, religion, creed, sex, marital status, age, national origin, ancestry, disability, medical condition, or any other consideration made unlawful by applicable federal, state, or local laws.  LIGHTHOUSE LIVING SERVICES, Inc. is an equal opportunity employer and selects employees on the basis of qualifications. Please contact the Executive Director if you have any questions or complaints regarding this policy.

I authorize investigation of all statements contained in this application.  I understand that falsification, misrepresentation or omission of facts called for will result in immediate dismissal or removal of my application from consideration.  I authorize LIGHTHOUSE LIVING SERVICES, Inc. to secure information about my experience with former employers, education institutions and agencies, and for those parties to provide information concerning my experience, releasing all parties from any liability arising therefrom.

If I am employed by LIGHTHOUSE LIVING SERVICES, Inc., I agree to conform to the rules and regulations of the Company.  I also understand and agree that, except for the employment at-will and the arbitration agreements, my wages, hours, working conditions, job assignment(s) and compensation rate(s) are subject to change by the Company.  I understand my employment can be terminated, with or without notice, at any time at the option of the Company or myself.  I understand that, other than the Executive Director of LIGHTHOUSE LIVING SERVICES, Inc., no manager, supervisor or representative of the Company has authority to enter into any agreement for employment for any special period of time, or to make any agreement contrary to the foregoing.  Only the Executive Director of LIGHTHOUSE LIVING SERVICES, Inc. has the authority to make any agreement contrary to the foregoing and then only in writing.

My signature below certifies that I have read and understand the foregoing and, to the best of my knowledge and belief, the information on this form is true and correct.

My signature below also certifies that I agree to the employment at-will relationship and arbitration agreement and agree to be bound by the terms and conditions of employment stated in this application if I am employed by LIGHTHOUSE LIVING SERVICES, Inc.  This application contains all the understanding and agreement by and between me and the Company, and supersedes all prior and/or contemporaneous practices, oral or written agreements, understandings, statements, representations and promises, expressed or implied, between me and the Company.  I understand and agree that no person who is either an agent or employee of the Company may modify, delete, vary or contradict, whether orally or in writing, the terms and of employment set forth herein.