Personal Information

Legal Name

Legal Name as shown on your passport, driver's license or photo ID

More Info
Marital Status

Please note that it is a policy of Laurelbrook Sanitarium and School that if married, both parties must apply for membership and submit separate applications.

Education & Training
Desired Position
Work Experience
Please provide a continuous history of your activities for the las 10 years.

Most recent first

Please provide three references of people not related to you that know you well. At least one should have known you for five or more years and another should be your church pastor.
Reference Name 1
Reference Name 2
Reference Name 3
Family Information
Complete name of Spouse

If married

Dependent Name 1
Dependent Name 2
Dependent Name 3
Dependent Name 4
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General Information

As part of our hiring background and investigation, we may obtain consumer reports or prepare an investigative consumer report. The investigative consumer report may consist of contacting all listed prior employers to verify your employment history. It may also include, but not be limited to, credit information reports, criminal history reports and driving history records. Under the provisions of the Fair Credit Reporting Act (15 USC at 1681-1681u) as amended, before we can seek such reports, we must have your written permission to obtain the information. You have the right, upon written request, to a complete and accurate disclosure of the nature and scope of the investigation. You are also entitled to a copy of your Rights under the Fair Credit reporting Act. The information that we collect in our background check will be used for hiring purposes only and seen only by personnel involved in the hiring process. Any violation of this procedure will be cause for dismissal and prosecuted to the full extent of the law. All records are kept stored in locked file cabinet, and retained for 5 years. After 5 years all records are shredded.


I release my previous/current employer, references, Laurelbrook Sanitarium and School, their agents, and employees from any liability or claims I may have which arise or result from any reference provided pursuant to this authorization or any authorized disclosure thereof. I agree and authorize Laurelbrook Sanitarium and School to request information from persons I have both chosen to include or exclude in my list of references. Submission of this application serves as my signature and authorizes Laurelbrook Sanitarium and School Inc. and or persons or organizations acting on their behalf, access to this application for membership consideration.