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One West Avenue LeRoy, NY 14482

Employment Application

Personal Information

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Prior Work Experience

Current or Most Recent

Dates of Employment


Dates of Employment


Dates of Employment


High School


Trade School


Personal References

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  1. The above information is complete and true to the best of knowledge.
  2. If employed by The Greens of LeRoy, I agree to abide by its rules and regulations.
  3. Any misrepresentation or omission will also be cause for The Greens of LeRoy refusing to hire me.
  4. I hereby authorize all persons, companies and corporations to release and provide any and all information regarding my employment to The Greens of LeRoy and release The Greens of LeRoy from all liabilities for issuing this information.

The Greens of LeRoy is an Equal Opportunity Employer and complies fully with Federal and New York State laws prohibiting discrimination in employment because of sex, age, race, color, creed, national origin, religion, marital status, availability for military services, disability, sexual orientation or arrest/conviction record.

The Greens of LeRoy will make reasonable accommodations to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodations would impose an undue hardship or a significant risk of substantial harm.