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Last Name*

Email Address*

Phone*

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Resume*

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How did you hear about this position?*

If an employee of The Villages Health referred you, please provide their First and Last name:

Have you previously worked for The Villages Health or The Villages?*

If you previously worked for The Villages Health or The Villages, please list where you worked and timeframe.

What is the highest level of education you have completed to date?*

What subject(s) or major(s) did you get a degree in?

Are you currently enrolled in school?*

List your current licenses, certifications, and/or professional memberships. If you do not have any, please answer "not applicable".

Please share any professional honors and/or awards. If none, please answer "not applicable".

Have you ever been convicted of a crime? (A conviction will not automatically bar employment.) If yes, please explain below.*

If you answered yes above, please briefly explain.

Are you willing to undergo a background check in accordance with local law and regulations as a condition of hire and ongoing employment?*

Are you legally authorized to work in the United States for our company?*

Do you now, or will you in the future, require sponsorship for employment visa status to legally work for our company in the United States? (e.g., H-1B visa status)*

Are you at least 18 years of age?*

What is your desired salary range?*

Do you want to tell us anything else about yourself?

SELF-ATTESTATION

I certify that I have read and understand the applicant instructions included with this application and that the answers given by me to the foregoing questions and statements made by me are complete and true to the best of my knowledge and belief.

I understand that any false information, omissions, or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment.

I understand that The Villages Health is an equal opportunity employer and does not unlawfully discriminate in employment and this application form is intended for use in evaluating my qualifications for employment and that this application is not an offer of employment.

I further understand that if hired, my employment will be considered "at-will" and that my employment may be terminated for any reason, with or without cause or notice, at any time by me or the Company and that this application is not intended to constitute a contract of continued employment.

I hereby authorize The Villages Health to contact, obtain, and verify the accuracy contained in this application. I authorize all persons, educational institutions, corporations, companies, agencies, and references to supply any information concerning my background. This includes authorizing the release of information about non-judicial punishment that might have occurred in any branch of the military service. If an official background check of my credit and criminal history is needed, a separate Disclosure Statement and Authorization will be provided to me.

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