Application for EmploymentThe Highlands at Pittsford Should you be contacted for an interview, you will be required to complete an application for employment. If you are human, leave this field blank. Position Desired * Salary Requirement * Date Available * Availability * Full-Time Part-Time Per Diem Temporary Shift Rotation (Day/Eve, Eve/Night, or Night/Day Days Evenings Nights Weekdays Contact and Personal Information First Name * Last Name * Email * Address * City * State * Zip * Phone * Alternate Phone Were you known under any other name in previous positions listed on this application? * Yes No If so, what name ? Are you legally authorized to work in the United States? * Yes No Are you 18 years of age or older? * Yes No If not, state age here Do you have a valid work permit? * Yes No Date Details Date Details Date Details Have you ever been employed at The Highlands Living Center, The Highlands at Pittsford, The Highlands at Brighton or any UR Medicine affiliate (University of Rochester, Strong Memorial Hospital, Highland Hospital, Visiting Nurse Service, Visiting Nurse Signature Care/CCR, F.F. Thompson Health System, High Tech Rochester) * Yes No If so, when ? Why did you leave? Do you have any relatives who work at The Highlands Living Center OR The Highlands at Pittsford? Yes No If yes, please list names and departments How did you hear about this position? Ad Internet Employee Other If Employee, please enter their name If Other, please describe License Are you a certified or registered professional? Yes No Which state(s) ? Date of certification, registration, or application Certificate/Registration Application # Education Please indicate your highest level of education * Some High School High School or Equivalent Some College Associate Degree Bachelor's Degree Master's Degree Doctorate Work History Position Title * From * To * Employer Name * Supervisor (First / Last) * Employer Address City State Zip Job Duties * Reason for leaving ? * Position Title From To Employer Name Supervisor (First / Last) Employer Address City State Zip Job Duties Reason for leaving ? Position Title From To Employer Name Supervisor (First / Last) Employer Address City State Zip Job Duties Reason for leaving ? May we check references with your present and form employer? Yes No If not, why ? Upload Resume Upload a resume to be included with your application Drop a file here or click to upload Choose File Maximum upload size: 2.1MB Optional cover letter to be included with your application Drop a file here or click to upload Choose File Maximum upload size: 2.1MB reCAPTCHA Please check the box above to prove you are a person.