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Job Application

for Lady of the Sea General Hospital

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PRN Housekeeper in Environmental Services


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3PROFESSIONAL INFORMATION Type of Employment: (check all that apply)

Days Available: (check all that apply)

Professional Information(if applicable):

Are you:
*** A previous employee?    
*** 18 or over?    
*** A citizen of the United States?    
*** Legally able to work in the U.S.?    
*** A licensed driver with a car available for work?    

*** Fully vaccinated for COVID-19?    

Please tell us how you became informed about this position: (choose one)  
Lady of the Sea website  
Family or Friends  

 ------Business or Tech------ 

 ------College or University------ 

 ------Other Training------ 

5REFERENCES * Be sure to complete all fields for each of your references *

 ------Employment Reference (1)------ 

 ------Employment Reference (2)------ 

 ------Employment Reference (3)------ 

 ------Employment Reference (4)------ 

 ------Personal Reference (1)------ 

 ------Personal Reference (2)------ 


NOTICE: Immediate family members of the Board of Commissioners and CEO may not be eligible to work at this facility.  Also, immediate family members of Managers may not be eligible to work in that manager's department.

*** Do you have a relative who is a member of the Board of Commissioners at Lady of the Sea?
*** Do you have a relative employed at Lady of the Sea?


I certify that all information given on this application is true, correct and complete.
I certify that I have accounted for all of my work experience and training.
I understand that any false information, willful or negligent misrepresentation, or failure to disclose any requested information will constitute sufficient grounds for Lady of the Sea General Hospital to cancel consideration for employment or to terminate my employment without notice.
I authorize any inquiry to be made on any information contained in this application.
I authorize any previous employers, schools, or persons named as reference to give any information regarding my employment offer is not tendered, is withdrawn or my employment is terminated of falsity of statements, answers or omissions made by me in this application.
I hereby release said employers, schools, or persons from all liability for any damages whatsoever for issuing this information.
I agree to submit to a physical examination and drug screening and understand that provided Lady of the Sea General Hospital otherwise wishes to hire me, my employment at Lady of the Sea General Hospital depends upon the results of such examination and screening being acceptable to Lady of the Sea General Hospital.
I understand that operating conditions may require me to temporarily work shifts other than the one for which I am applying and I agree to such scheduling changes as directed by my supervisor/manager.
I further understand that an offer of employment does not constitute a contract between the applicant and Lady of the Sea General Hospital.
I understand that if employed, such employment is for an indefinite period, may be terminated by Lady of the Sea General Hospital or the applicant at any time with or without cause, and is subject to change in wages, conditions, benefits, and operating policies at Lady of the Sea General Hospital.
If employment is obtained under this application, I will comply with all policies and procedures of Lady of the Sea General Hospital.
I have read the description of the position available that I am applying for and can meet the physical requirements thereof.

Lady of the Sea General Hospital does not discriminate on the basis of any protective status.

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ALERT: Scammers may pose as a familiar company to trick you into sending them money. Lady of the Sea will never ask you to send money for equipment or any other reason to us or anyone else when seeking employment. We also will not ask for personal identity information electronically (ex: Social Security Number) until you receive a job offer and meet personally with Human Resources for additional information.

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Latest application revision: 05/2022

Trouble with this form? Please contact us at (985) 325-9335.