For more detailed information or any questions please 
516-935-5555 ext. 24 • Fax 516-935-0407

The Beechwood Organization  Online Employment Application
The Beechwood Organization is looking for qualified people to work in our friendly
and professional environment. Please take a few moments to fill out this application!

Contact Information
Your Name:
Internet E-Mail:
Home Phone:
Address:
City:
State:
Zip:
Soc. Security #:
Position Information
Position you are
interested in:
Are you interested in:
Full Time: Part Time: Temporary:
What days and hours are
you available?:
What pay do you expect?:
When can you start work?:
Current Status Information
Do you have a current valid Driver's License?:
   Yes:    No:
If so which state?:
Are you currently employed?
   Yes:    No:
If so by whom?:
Have you ever been employed at
Beechwood Org. before?
   Yes:    No:
If so what position and what dates were you employed?:
Do you have any relatives currently working at Beechwood Org.?
(will not necessarily disqualify employment):
   Yes:    No:
If yes, please list their names:
 Employee1:
  Employee2:
  Employee3:
Education Information
Did you graduate high school?:
   Yes:    No:
Did you graduate college?:
   Yes:    No:
If so, what college?:
If you didn't graduate college, how many years did you attend?:
1 Year: 2 Years:
3 Years: 4 Years:
More than 4 Years:  
General Information
Have you ever been convicted of a felony or misdemeanor in the last 5 years, with the exception of a first conviction for drunkeness, simple assault, speeding, minor traffic violations, affray or disturbance of peace?:
   Yes:    No:
If yes, explain.
(Conviction will not  necessarily disqualify.)
Can you, if employed, submit verification of
your right to work in
the United States?
   Yes:    No:
Employment History - Position 1
List Present and Past Employers, MOST RECENT FIRST. Personal references may be listed following employment history, please no relatives.
Employer:
Address:
Phone:
Fax:
Position:
Start Date:
Termination Date:
Supervisor:
Starting Salary:
Ending Salary:
Duties:
Reason for leaving:
Additional Comments:
Employment History - Position 2
Employer:
Address:
Phone:
Fax:
Position:
Start Date:
Termination Date:
Supervisor:
Starting Salary:
Ending Salary:
Duties:
Reason for leaving:
Additional Comments:
Employment History - Position 3
Employer:
Address:
Phone:
Fax:
Position:
Start Date:
Termination Date:
Supervisor:
Starting Salary:
Ending Salary:
Duties:
Reason for leaving:
Additional Comments:

Applicant's Certification and Agreement

I hereby certify that the facts set forth in the above application are true and complete to the best of my knowledge. I understand that any false answers or statements or implications made by me in this application or other documents shall be considered sufficient cause for denial of employment or discharge.

I thereby give The Beechwood Organization the right to make a thorough investigation of my past employment, education and training which would include the verification of the information set forth on this application of employment. I release from all liability, all persons, companies and corporations supplying such information. I indemnify The Beechwood Organization against any liability which might result from making such an investigation.

I also understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract. Any offer of employment is contingent upon undergoing verification of information obtained during the interviewing process, satisfactory reference checks, completion and passing a pre-employment drug test.


    

* Information contained herein is for informational purposes only, and shall not be
binding upon The Beechwood Organization.