Join Our Team


Brilliance Assisted Living is always looking for talented team members.

APPLICATION FOR EMPLOYMENT


EDUCATION

RowNumberEducationSchool / CollgeDate of AttendanceCredit Hours EarnedMajor Course Of StudyType Of Degree Earned 
1

JOB-RELATED TRAINING OR COURSE WORK

RowNumberName Of SchoolLocationDate Of AttendanceHours EarnedCourse Of StudyTraining Completed 
1

LICENSE/REGISTRATION/CERTIFICATION

RowNumberLicense, Registration,Or CertificationNumberDate ReceivedExpiration DateIssuing Agency 
1

EMPLOYMENT

List All Employers Beginning With The Current Or Most Recent Employer

RowNumberName, Address, & TelephoneEmployment DatesHours WorkedReason For LeavingSalary 
1

REFERENCES

RowNumberNameRelationshipAddressTelephone Number 
1

BACKGROUND INFORMATION

Are you legally authorized to work in the United States?

Yes

No

Florida law requires certain employees of assisted living facilities to be background screened. This includes a search of the Department of Children & Families Abuse Registry, an FDLE Criminal Background Check, and may include an FBI fingerprint check

Have you already had a background screening conducted?

Yes

No

If yes, how long ago?

How may we obtain a copy of that screening?

If no, do you object to having a screening conducted?

I consent to an investigation of all statements contained in this application. I certify that to the best of my knowledge and belief all of the statements contained herein and on any attachments are true, correct, complete, and made in good faith. I am aware that any omissions, falsifications, misstatements, or misrepresentations may disqualify me from employment, or may be grounds for termination at a later date.