:: Assisted Living in Florida ::

VOLUNTEER

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RELATION

ADDRESS

ZIP CODE

TELEPHONE

Volunteer opportunities are available for students or those who wish to serve the elderly. Volunteer hours are given to students who need to fulfill their school or college requirements. A Background Screening and Physician clearance is required for all volunteers.

Opportunities include:

1. Documentation requiring computer skills.
2. Activities and entertainment for stimulation.
3. Marketing and Public relation skills.
4. Secretarial and Clerical skills.
5. Telephone communications.
6. Counseling and Discussions.
7. Helping the elderly with their desired chores.

Volunteer Information
Emergency Contact
Education
Reference
Background
Upload Resume
Consent


INTERNSHIP INFORMATION:

*Our organization does not employ LPNs and RNs.

Last Name*

Middle Name

First Name*

How did you find us?

Agency Name

Describe

Cell Phone*		- -

Alt Phone		- -

E-mail

Address*

City*

State*

Zip Code*

DOB*

Place of Birth*:

SSN*:		- -

Re-enter SSN*:		- -

Sex* :		Male Female

Race*:

Eye Color*:

Hair Color*

Height*:

Weight*:		Lbs

Country of citizenship*

EMERGENCY CONTACT:


Last Name*

First Name*

CellPhone*		- -

Home		- -

Work		- -

Email

Address

City

State

Zip Code

EDUCATION:

Education
Education	Name & Location of School	Dates of Attendance	Major Course of Study	Degree Earned

Preferred Area of Interest
Please explain the area in which you would like to work in our facility

REFERENCES*:

BACKGROUND INFORMATION

*Are you legally authorized to work in United States?		Yes No
Florida law requires certain employees of assisted living facilities to be background screened. This includes a search of the Department of Children & Families Abuse Registry, an FDLE Criminal Background Check, and may include an FBI fingerprint check.
Have you already had a background screening conducted?		Yes No
If yes,how long ago?
How may we obtain a copy of that screening?
*If no, do you object to having that screening conducted?
*Have you ever had any abuse or neglect cases against you ?		Yes No

CONSENT:

Why should we hire you?*
I consent to an investigation of all statements contained in this application.I certify that to the best of my knowledge and belief,all of the statements contained herein and on any attachments are true, correct,complete, and made in good faith.I am aware that any omissions,falsifications, misstatements, or misrepresentations may disqualify me from employment,or may be grounds for termination at a later date.
Signature*			Date*

Type the characters you see


The form can be submitted electronically or by Fax: 954-255-3471 or by mail at : AssistedLivingInFlorida.com 1780 N.W. 112th Terrace Coral Springs,Florida 33071. Resume can be attached if available.

Upload Resume:


Resume

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