(410) 800-4226. referrals@davidsloft.com

EMPLOYMENT APPLICATION

 
 
Please fill in all the form fields as accurately as possible. If there is missing or incomplete information, it may cause a delay in processing your application.

 

 

    GENERAL INFORMATION

    Date:

    Position(s) Applied For:

    Referral Source:

     
     

    Name:
      

    Address:
      , 

    Phone:
     Cell Phone

    Email

    Are you currently employed?

    If yes, may we contact your employer?

    Employment desired:

    When are you available for work?

    Can you travel if a job requires it?  
     

    EDUCATION

    TYPE OF SCHOOL NAME OF SCHOOL LOCATION
    (Complete mailing address)
    NUMBER OF YEARS COMPLETED MAJOR & DEGREE
    High School
    College
    Graduate School
    Bus. or Trade School
    Professional School

    Additional Education:

    Special Honors:

    COMPUTER SKILLS
    Check those computer skills with which you are proficient (any version)

    (please list below if 'other')

    PROFESSIONAL LICENSE
    Do you have a current license?

    Professional license number:

    State of issue:   Expiration date:

    MILITARY
    Are you a veteran of the United States military service?   If yes, what branch?
    If yes, Date Entered:   Date Discharged:
    If yes, please describe any special skills or training acquired while in the service:

    OTHER SPECIAL SKILLS
    Please list other special skills you may have, e.g., fluency in other languages, licenses, special training required for the position for which you are applying, etc.

    WORK EXPERIENCE
    Please list your work experience beginning with your most recent job. If you were self-employed, give firm name. Exclude organization names which indicate race, color, creed, national origin, age, religion, sexual orientation, gender identity, gender expression, veteran status, or disability.

    Most Recent Employer
    Dates Employed
    From: 
    To:      
    Work Performed
    Address
    Supervisor
    Job Title
    Reason for Leaving
    Employer
    Dates Employed
    From: 
    To:      
    Work Performed
    Address
    Supervisor
    Job Title
    Reason for Leaving
    Employer
    Dates Employed
    From: 
    To:      
    Work Performed
    Address
    Supervisor
    Job Title
    Reason for Leaving
    Employer
    Dates Employed
    From: 
    To:      
    Work Performed
    Address
    Supervisor
    Job Title
    Reason for Leaving

    REFERENCES
    Please list two references other than relatives or previous employers.

    Name:         

    Position:      

    Company:   

    Address:     

    Telephone:

     
     
    Name:         

    Position:      

    Company:   

    Address:     

    Telephone:

     

    Additional Items: (optional)
    Please attach any additional items that you want to be considered with your application. Up to 3 documents. (Ex. professional certificates, recommendation letters, additional work experience, etc.)

    Acceptable file types .doc, .docx, .pdf, .jpeg, .jpg - Files must not be larger than 4MB per file
     



     

    WAIVERS AND DISCLOSURES

    Please read each section carefully and check where indicated.

    AT-WILL EMPLOYMENT

    It is my understanding that this employment application, or the granting of an oral interview, does not represent a contract of employment or a promise of future benefits by this organization. I understand and agree that, if hired; my employment will be at-will in nature and may be terminated, with or without cause, at any time, by either myself or my employer. I also understand that this written statement supersedes any and all oral representations made by agents or representatives of this organization.

    CERTIFICATION OF TRUTH AND ACCURACY

    I certify that the information in this application is true, complete and correct. I understand that false answers, statements, or significant omissions made by me on this form shall be sufficient cause for denial of employment or discharge.

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    David’s Loft Clinical Programs-South Charles Village

    2641 Mayland Avenue
    Baltimore, MD 21218
    (410) 800 – 4226 Office
    (410) 387 – 7637 Fax

    David’s Loft Clinical Programs-Towson

    21 West Road
    Suite 111
    Towson, MD 21204
    (410) 494-9440 Office
    (410) 494-9441 Fax