New Horizons of Northwest Florida, Inc. - Lighting the Way to Independence for over 74 years!
PRE-EMPLOYMENT APPLICATION
Name: Last, First, Middle (Full middle name)
Complete Address: Number, Street, City, State, Zip
Phone #: ( )
Email Address:
Have you ever been arrested, convicted, pled guilty or "no contest" to a felony?
Yes
No
SSN:
You must be 18 years old or older.
Highest Level of Education Completed (You must have at least a high school diploma or GED certificate.)
Type of work you are applying for. (You must be available on weekends.)
How many years experience have you had in this field?
List Last 3 Places & Dates of Employment
Have you been previously employed by New Horizons?
Yes
No
Are you related to or associated with any current employee? If so, give their name & relationship to you.
Date Employment Form Completed.
Do not apply more than once. You will be contacted when openings are available.








**PLEASE READ THE FOLLOWING STATEMENTS. 

BY COMPLETING THIS FORM I AM AGREEING TO THE FOLLOWING STATEMENTS BELOW. 

"The facts set forth in my application are true and complete.  I authorize the investigation of all statements contained in this application and hereby authorize my former employers to furnish all information pertaining to my work record.  I hereby release my former employers from all liability on account of furnishing such information.  I understand that false statement, omission or misleading statements on this application shall be considered sufficient cause for refusal to hire or dismissal and that
I agree that my employer shall not be held liable in any respect if my employment is terminated because of such omissions or false or misleading statements. 

Total Employee Leasing and New Horizons of Northwest FL, Inc. are hereby authorized to investigate my employment history, including the contacting of any employers listed."

















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