Sheboygan Senior Community Application for Employment
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Personal Information
Incomplete information could disqualify you from further consideration. Please complete all fields.
Date *
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Name *
Address *
Email *
Primary phone number & type (ex. cell, home, etc.) *
Secondary phone number & type (ex. cell, home, etc.)
Are you eligible to work in the U.S.? *
Are you fully vaccinated for Covid-19?
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Are you at least 18 years or older? *
Are you at least 16 years or older? *
What shifts can you work? Check all that apply. *
Required
Can you work weekends? *
Employment desired
Date you can start: *
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Position desired:
Hourly rate/salary desired: *
Are you currently employed? *
If so, may we inquire of your present employer?
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Referral source
How did you hear about us? *
If you have been referred by a current SSC employee, please list their name here:
Have you ever worked for Sheboygan Senior Community before? *
If yes, when?
Employment History
Start with your current or most recent position.
Name of employer & contact number:
Current salary/wage
Address
Supervisor's name and title
Date range worked
Describe the work performed
Name of employer & contact number:
Address
Supervisor's name and title
Date range worked
Describe the work performed
Have you ever been convicted of a felony? *
If yes, explain
Please list any certifications, professional licenses (Ex. CBRF, CNA, LPN, RN, ServSafe, etc.)
Do you have any special skills, experience, and/or training that would enhance your ability to perform the position applied for? If yes, explain.
Please read carefully before signing below.
Sheboygan Senior Community is an equal opportunity employer. Sheboygan Senior Community does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Sheboygan Senior Community to hire me. If I am hired, I understand that either Sheboygan Senior Community or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Sheboygan Senior Community has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to Sheboygan Senior Community true and complete information on this application. No requested information has been concealed. I authorize Sheboygan Senior Community to contact references provided for employment reference and criminal background checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.
Signature (Please type your name) *
Date *
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Submit
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