Application: Careers at Mainsail Lodging & Development

The following information is needed to complete verification procedures. Please read this form carefully, taking extra care to make your entries very clear and easy to read. Please make sure that you DO NOT use ant abbreviations from previous employers or schools. Incomplete applications (missing information) will NOT be considered. "See resume" is not acceptable.
Work History
Please list your work experience for the past ten years beginning with your most recent job held. If you were self-employed, give firm name.
Company #1
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Your Position
Employment Start Date
Employment End Date
Salary
Reason for leaving
May we contact this employer now?
- Yes
- No
If no, when?
Company #2:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Your Position
Employment Start Date
Employment End Date
Salary
Reason for leaving
May we contact this employer now?
- Yes
- No
If no, when?
Company #3
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Your Position
Employment Start Date
Employment End Date
Salary
Reason for leaving
May we contact this employer now?
- Yes
- No
If no, when?
Education
List highest level of educational degree, diploma, or GED received.
School Name
City/State
Diploma/Degree Received
Did you work for any employers or attend any schools under a different name?
- Yes
- No
If yes, which employer(s) or school(s)?
Under what name?
Electronic Signature
The information on this application is true and accurate to the best of my knowledge: (By typing your initials in the box below, you are agreeing to the above statement)
Initials
Name
First Last
Date

Agreement/Pre-Employment Agreement
I hereby authorize the potential employer to contact, obtain and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment, and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation or applicable state or federal laws.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in the immediate termination of employment.

I agree to submit to a drug screen as part of my application for employment. I understand that either refusal to submit to the drug screen, or failure to qualify according to the minimum standards established by Mainsail Lodging & Development for this screen, may disqualify me from further consideration for employment. I will be tested for the following drug categories: marihuana, cocaine, amphetamines, Opiates-Codeine & Morphin, and PCP.

*If I am injured in the course and scope of my employment and test positive; I forfeit my eligibility for medical and indemnity benefits under the Workers Compensation Act upon exhaustion of the remedies provided in Florida Statute 440.102(5).

Any candidate with positive drug test results will be denied employment. The company will not discriminate against candidates for employment because of past abuse of drugs or alcohol. It is the current abuse of drugs or alcohol that which prevents employees from properly performing their jobs that Mainsail Lodging & Development will not tolerate. All results from drug screening will be kept confidential.

I have read in full and understand the above statements and conditions of employment as specified by company policy, and furthermore seek employment under these conditions.
Electronic Signature
The information on this application is true and accurate to the best of my knowledge: (By typing your initials in the box below, you are agreeing to the above statement)
Initials
Name
First Last
Date

Medical Express Corporation Authorization and Release
Medical Express Corporation is acting as a clearinghouse for background information as described in the following Authorization and Release.

I hereby authorize without condition, except as provided for under the provisions of the Fair Credit Reporting Act (FCRA) any vendor or agency contacted by Medical Express to provide personal and private information pertaining to my driving record which may contain records concerning accidents, traffic violations and certain criminal offenses.

I further authorize Medical Express to access consumer reports which may contain public and private information from county and state criminal repositories, educational institutions, federal, state and county institutions, credit bureaus and former employers. I understand this report may contain information pertaining to my character, education, work history, credit history, accidents, workers' compensation claims, conduct, work experience and terminations.

I understand the right to make a written request to Medical Express for additional information concerning any report obtained on my behalf. I understand that I am within that right to dispute the accuracy of any information contained in said record either by mail or in person at the address of Medical Express Corporation, 4237 Salisbury Road, Suite 304, Jacksonville, Florida 32216.

I hereby authorize the below named company in conjunction with Medical Express Corporation to conduct this investigation as set forth in the above.

Mainsail Lodging & Development
Name
First Last
Maiden Name (if applicable)
First Last
Current Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Prior Address (or addresses if more than one) List full addresses in box below:
If less than 7 yrs. combined with previous address, MUST continue with listing a 3rd address in the same box.
Drivers License #
State
Electronic Signature
By typing in your initials in the box below, you are agreeing to the above statements.
Initials
Date

Step 1 of 4

Your Contact Information

Work History

Education

Electronic Signature

Agreement/Pre-Employment Agreement

Electronic Signature

Medical Express Corporation Authorization and Release

Electronic Signature