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All qualified applicants receive consideration for open positions without regard to race, sex, religion, national origin, disability, sexual orientation, gender identity, marital or veteran status, or pregnancy. Masonic Homes of Kentucky is an equal opportunity employer.

Please complete the following. Fields marked with * are required for consideration.

I'm applying for a position in:
Position I am interested in:
How did you hear about us:
Date available: *


Personal Information

First Name: *
Last Name: *
Phone: *
Email: *
Address: *
City: *
State: * Zip/Postal: *

Are you 18 years of age or older? *
Yes No
Are you legally entitled to work in the USA? *
Yes No

Have you been convicted of feflony or misdemeanor offense? *
Yes No
If yes, state date and disposition:


High School Education
Name:
City:
State:
Did you Graduate? Yes No
If no, number of hours completed:
Grade Point Average:


College Education
Name:
Address:
State:
Did you Graduate? Yes No
If no, number of hours completed:
Grade Point Average:
Degree:
Major:
Minor:
Graduation Date:


Professional License / Certification
License / Certification Type:
State:
Number:
Expiration Date:
If you aren't licensed in KY, have you applied?
Yes No

Has any state denied, limited, suspended, sanctioned, revoked or not renewed your license?
Yes No

If yes, please explain:


General Employment
I want to work:

Masonic Homes of Kentucky properties are open 24/7 and employees are required to work various shifts, some weekends and holidays. Are you prepared to work such a schedule?
Yes No

Number of hours per week you can work:  

If NO, are you willing to work:

First Shift
Second Shift
Third Shift
Overtime or Weekends

How will you get to work:

Have you ever been employeed by Masonic Homes of KY?
Yes No
If yes, when and why did you leave?
List friends or relatives employed by Masonic Homes:


Emergency Contact

First Name
Last Name
Phone
Relationship


Employment History

Company 1 Name
Address
Phone
Job Title
Date Employed From
Date Employed To
Starting Salary (per hour)
Starting Salary (per week)
Final Salary (per hour)
Final Salary (per week)

Company 2 Name
Address
Phone
Job Title
Date Employed From
Date Employed To
Starting Salary (per hour)
Starting Salary (per week)
Final Salary (per hour)
Final Salary (per week)

Company 3 Name
Address
Phone
Job Title
Date Employed From
Date Employed To
Starting Salary (per hour)
Starting Salary (per week)
Final Salary (per hour)
Final Salary (per week)

Company 4 Name
Address
Phone
Job Title
Date Employed From
Date Employed To
Starting Salary (per hour)
Starting Salary (per week)
Final Salary (per hour)
Final Salary (per week)

Company 5 Name
Address
Phone
Job Title
Date Employed From
Date Employed To
Starting Salary (per hour)
Starting Salary (per week)
Final Salary (per hour)
Final Salary (per week)


References

Please list people who can attest to your professional qualifications and personal capabilities.

Reference 1 Name
Address
Phone
Relationship
Reference 2 Name
Address
Phone
Relationship
Reference 3 Name
Address
Phone
Relationship

____________________________________________________

SUBMIT APPLICATION

The facts set forth in this application are true and correct. I understand that if employed, false statements on this application shall be considered sufficient grounds for dismissal. I understand that if offered a position with Masonic Homes of Kentucky, pre-employment medical examination, drug screening and background check may be required. I understand that this application is not a contract of employment.

 Check here to acknowledge acceptance
         of these conditions.


  
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