Dignity Privacy Independence
"How far you go in life depends on your being tender with the young, compassionate with the aged, sympathetic with the striving, and tolerant with the weak and strong, because some day in your life you will have been all of these"- George W. Carver

Application For Employment

An Equal Opportunity Employer

It is the policy of Groom Senior Living Inc. to provide employment opportunities without regard to race, color, religion, sex, national origin, age, handicap, or veteran status.

Personal Data




Date of Birth

Are you legally authorized to work in the United States?

Do you have a work visa?

Work Visa Information

Do you have a valid drivers license?

Drivers License Info

Have you ever been convicted of or sentenced for any violation of the law?

If yes, give full particulars.

Position Information

Position Applied For

Will you work any shift, including nights and weekends?

How soon following notification can you report?

Have you ever been employed by Groom Senior Living Inc.?

If yes, when?


What Position?

Are any relatives, including in-laws, employed at the company?

If yes, give name




Have you ever previously applied for employment at the Groom?

If yes, when?

Have you ever previously been interviewed by the company?

If yes, when?

For what Position?

Do you have any medical or physical limitations that would prevent you from performing or working on the job?


Have you attended High School?

Last High School Attended



Have you attended College or University?

College or University Attended



Major and Degree

Would you like to add another College or University?

College or University Attended



Major and Degree

Have you attended Other (Technical, Vocation, Graduate, etc.)?

Other (Technical, Vocation, Graduate, etc.) Attended



Major and Degree

List any scholarships, academic honors, awards or special achievements:

Do you speak any languages other than English?

In what languages other than English can you converse?

Employment History

Do you have previous work experience?

Starting with your present or most recent employer, list in consecutive order all employment and periods of unemployment since you graduated from or last attended high school.

Present or Most Recent Employer


Street Address



Additional Information

List 3 reasons you would like to work for Groom Senior Living Inc.


List any other skills you think may be of value to the company

Military Service and Status

Have you served in any branch of the United States Military?

Branch of service:

Military Occupation

Date of entry into active duty

Date of separation

Rank at the time of separation

E-mail Address

Enter your E-mail address to receive a copy of the submitted application