Application for Employment


Suncoast Center, Inc. is an Equal Employment Opportunity Corporation which makes employment decisions without regard to race, color, sex, religion, national origin, age, handicap, disability, marital or veteran status, or sexual orientation. Suncoast Center also reasonably accommodates individuals with handicaps, disabilities and bona fide religious beliefs.

Suncoast Center is a Drug-Free Workplace and abides by the Clean Air Act.
(Preference given to non-smokers)

Please answer all questions completely:

       
 

Select the Position you are applying for:
  (View All Open Positions)

 
 
Your Personal Data
 
 
Last Name

First Name

Middle
 
 
Address
 
 
Unit/Apt #
 
 
City

State

Zip Code

Phone Number
 
 
Email Address
       
           
  Are you at least 18 years old?  
  If not, state your age for
child labor law purposes only:
 
  Are there any days, shifts or hours you will not work?  
  If Yes, please explain:  
  Will you work overtime if required?    
  When will you be able to start work?  
  Have you ever been convicted of a felony or do you have any pending arrests or convictions? (A conviction will not necessarily disqualify you)  
  If Yes, please explain
and provide dates:
 
  Can you, within 3 days of employment, submit documentation verifying that you are legally eligible to work in the United States?  
  Have you taken any illegal drugs in the last 30 days?  
  How did you learn of our company?  
  Have you ever applied or worked at Suncoast before?  
  If Yes, please provide dates:  
  List any relatives currently employed at Suncoast Center, otherwise enter "none":  
  If you were referred by an employee of Suncoast Center, enter that employee's name here:  
   
Your Emergency Contact Data

Please provide contact person information in case of an emergency:
 
   
Emergency Contact Last Name
 
First Name
 
Relationship
 
   
Address
 
   
City
 
State
 
Zip Code
 
Phone Number
 
   
Your Employment History

Please complete for all full-time or part-time employment beginning with the most recent employer:
 
  Company Name:  
  Company Address:  
  Telephone:  
  Name of Supervisor:  
  Dates Employed:   From: (mo/yr) To: (mo/yr)  
  Hourly/Annual Pay:  
  Ending Salary:  
  Job Title(s) Held at This Employer:  
  Description of Job Duties:  
  Reason for Leaving:  
 
 
  Company Name:  
  Company Address:  
  Telephone:  
  Name of Supervisor:  
  Dates Employed:   From: (mo/yr) To: (mo/yr)  
  Hourly/Annual Pay:  
  Ending Salary:  
  Job Title(s) Held at This Employer:  
  Description of Job Duties:  
  Reason for Leaving:  
 
 
  Company Name:  
  Company Address:  
  Telephone:  
  Name of Supervisor:  
  Dates Employed:   From: (mo/yr) To: (mo/yr)  
  Hourly/Annual Pay:  
  Ending Salary:  
  Job Title(s) Held at This Employer:  
  Description of Job Duties:  
  Reason for Leaving:  
 
 
  Company Name:  
  Company Address:  
  Telephone:  
  Name of Supervisor:  
  Dates Employed:   From: (mo/yr) To: (mo/yr)  
  Hourly/Annual Pay:  
  Ending Salary:  
  Job Title(s) Held at This Employer:  
  Description of Job Duties:  
  Reason for Leaving:  
 
 
 

Please explain any gaps in your employment history:

 
 

List any work-related skills, training or experience you believe are relevant to the job applied for:

 
  Have you ever been discharged or forced to resign?    
 

If you answered yes above please explain:

 
  Did you receive any discipline in the last 12 months of active employment?    
 

If you answered yes above please explain:

 
  Were you given a performance evaluation within the past 12 months of active employment?    
 

If you answered yes above, what was the range of scores used and what was your score?

 
  Have you ever signed any non-compete agreement with any other employer that would restrict you from working with this company?    
 

If you answered yes above please explain:

 
 
Your Education
(may or may not be considered depending on job applied for)
   
 
 

Describe any educational degrees, skills training or experience you believe are relevant to the job applied for:

 
 

Certifications/Licenses:

 
 


Military
(Complete this section only if you served in the military)
   

 
  Branch of Service:  
  Dates of Service:   From: (mo/yr) To: (mo/yr)  
  Rank at Discharge:  
  Date of Discharge:  
  Were you honorably discharged?  
 

Describe any military skills training or experience you believe are relevant to the job applied for:

 
 


Driving Record
(may or may not be considered depending on job applied for)
   

 
  Do you have a valid Florida Driver's License?    
  Have you had any moving violations in the past 5 years?    
 

If you answered yes above please explain:

 
  Have you had any DUI or DWI convictions?    
 

If you answered yes above please explain:

 
  Do you have a reliable form of transportation to work?    
  Referral Source for this position:    
 


Equal Employment Opportunity Survey
Applications are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, sexual orientation, marital or veteran status, medical condition or handicap.

As employers/government contractors, we comply with governmental regulations and affirmative action responsibilities.

Solely to help us comply with government record keeping, reporting and other legal requirements, please fill out the Equal Employment Opportunity Survey below. We appreciate your cooperation.

This data is for periodic governmental reporting and will be kept in a confidential file separate from the Application for Employment.

Affirmative Action Survey
Government agencies require periodic reports on the sex, ethnicity, handicapped and veteran status of applicants. This data is for analysis and affirmative action only. Submission of the following information is voluntary:

 
 
 

Sex:           

Race/Ethnic Group:
      Select Veteran/Handicap:
     
 
 


Resume
You may paste a text version of your resume in the field below (1200 characters max):
 

 
 

 
 


Tobacco Free Agreement
The use of tobacco and tobacco products is a known and established hazard to the health and wellbeing of those who use them. The health problems created by the use of these products contribute to the increase in health care costs and the rise in insurance premiums. Use of tobacco and tobacco products has been shown to decrease employee productivity and efficiency and increase absenteeism.

It is in recognition of these factors that Suncoast Center, Inc. has taken measures to develop a tobacco free workforce.

On July 1, 2013, and thereafter, candidates seeking employment with Suncoast Center, Inc. will be required to sign this affidavit indicating whether or not they have used tobacco or tobacco products within the six (6) months immediately preceding their application for employment.

Due to Suncoast Center, Inc.’s adherence to the Florida Clean Air Act, preference shall be given to applicants that are non-smokers.

Please select the statement that applies to you:

 

I have NOT used tobacco or tobacco products in the six (6) months immediately preceding the date of my application for employment.

I have used tobacco or tobacco products in the six (6) months immediately preceding the date of my application for employment.

Applicant's Agreement
I, (type your full name:)  , affirm that the above information is true. If employed by Suncoast Center, Inc., I agree to abide by all policies regarding the tobacco free work environment established by Suncoast Center, Inc.

I understand that falsifying this document or any other part of my application may cause me to be denied employment or terminated from employment with Suncoast Center, Inc.

If this information changes at a future date, I agree to notify Human Resources so that the status of my employment eligibility may be updated.

Applicant's Acknowledgement
I certify that the answers given herein are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of facts or incomplete answers in any application document will disqualify me from further consideration for employment. I further understand that, if employed, any misrepresentations or omissions of facts in any application document will be cause for my dismissal at any time without prior notice. Suncoast Center regularly conducts background checks.

I understand that no oral promise, employer policy, custom, business practice or other procedure (including the Employer’s Human Resources Manual or any manuals) constitutes an employment contract or modification of the at-will employment relationship between Suncoast Center and me.

I understand that this application will remain active for 30 days from this date. If I have not heard from Suncoast Center at the conclusion of this 30 day period, it is my responsibility to complete a new application if I still wish to be considered for employment by Suncoast Center.

All applicants being considered for employment are required to be tested for the presence of illegal drugs. A negative drug test is a requirement of employment. A test positive for the presence of illegal drugs will lead to immediate termination of employment.

Some positions require a satisfactory driving record and agency-required levels of personal automobile insurance. An employee in one of these positions will be subject to immediate termination of employment if his/her driving record is unacceptable to Suncoast Center and/or our insurance company.

By entering my electronic signature on this statement, I hereby give my permission for Suncoast Center for Community Mental Health, Inc. to check any and all references listed on this application.

 

 
  Enter your full name here as your electronic signature:  Date:   
 
 

Please check your information and then click below:

 

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