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Thank you for considering Whitehall Boca in your job search. Whitehall Boca is an equal employment opportunity employer and does not discriminate on the basis of sex, age, race, color, religion, national origin, mental or physical disability, sexual orientation, political affiliation, marital or veteran status. No application will be rejected as a result of disability that, with reasonable accommodation, does not prevent performance of the essential job duties. Applications will remain on site and active for a period of three (3) months from the date of completion.
Whitehall Boca is dedicated to providing a healthful, comfortable, and productive work environment for all our employees, patients and visitors. Because of the acknowledged health hazards arising from exposure to secondhand smoke, it will be our policy to provide a smoke-free workplace effective September 1, 2008. All employees hired after August 31, 2008 must be non-smokers and must sign the Employment Application attesting to this fact.
NOTE: Please fill out this application as completely as possible. Pay special attention to areas that require information, indicated by the red asterisk. However, if you encounter a question or field that you’re sure does not apply to you — for example, if you do not currently have a work phone number — then type “n/a” (without quotes) for “not applicable.”
* = required information
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Personal Information
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* Last Name:
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* First Name:
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* Street Address:
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* City:
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* State
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* Zip Code:
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* Country:
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* Home Phone:
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Work Phone:
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* E-Mail Address:
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Desired Employment
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Position Desired:
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Job Schedule:
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Shift Desired (Nursing Only):
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To Elaborate or If You Chose “Other,” Please Explain Here:
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Salary Desired:
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Date You Can Start:
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Referred By:
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* Resume — Optional
If you have a thorough resume that you would like to paste into the indicated area below, you may skip the sections on “Education/Training” and “Employment Record.” However, you must still fill out all other areas of this form. (It is best to copy and paste from a resume in plain text format — those documents ending with “.txt.” Styling, such as italics and bold, are typically not preserved when copying and pasting from another format.)
To cut and paste your resume:
1. Highlight the text on the resume you want to copy.
2. Press “Ctrl C” to copy (command-C on the Mac).
3. Place the cursor in the “Paste Resume” box below.
4. Press “Ctrl V” (command-V on the Mac) to paste the information in.
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Paste Resume Here:
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Education/Training
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High School
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Name of School:
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City:
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State:
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Major Subjects:
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Years Completed:
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Did You Graduate?
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yes no
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College or University
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Name of Institution:
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City:
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State:
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Major Subjects:
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Years Completed:
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Did You Graduate?
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yes no
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Degree Received:
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Additional Schooling
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Name of School:
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City:
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State:
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Major Subjects:
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Years Completed:
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Did You Graduate?
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yes no
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Certificate or Degree:
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Special Skills
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Software Programs:
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Other Skills:
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Employment Record
Include military service as part of the employment record. Use designated “Employment Notes” area at the end of this employment section to account for any periods of unemployment of one month or more. Leave blank if it does not apply to you.
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Most Recent Employer
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Name of Employer:
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From Date:
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(month/year)
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To Date:
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(month/year)
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Employer Address:
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Employer Phone:
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Job Title:
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Supervisor’s Name:
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Your Duties and Responsibilities:
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Starting Salary:
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Ending Salary:
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Reason for Leaving:
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Previous Employer
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Name of Employer:
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From Date:
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(month/year)
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To Date:
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(month/year)
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Employer Address:
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Employer Phone:
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Job Title:
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Supervisor’s Name:
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Your Duties and Responsibilities:
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Starting Salary:
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Ending Salary:
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Reason for Leaving:
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Previous Employer
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Name of Employer:
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From Date:
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(month/year)
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To Date:
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(month/year)
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Employer Address:
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Employer Phone:
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Job Title:
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Supervisor’s Name:
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Your Duties and Responsibilities:
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Starting Salary:
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Ending Salary:
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Reason for Leaving:
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Employment Notes
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Explain gaps of more than one month in your employment history:
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General Information
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* Are you 18 years of age or older?
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yes no
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* Do you have the legal right to work in the United States?
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yes no
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* Do you have experience in, or have you ever worked in a similar industry or business before?
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yes no
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* If you answered “yes” to the last question, please explain here:
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* Have you ever been employed or attended school using any other name?
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yes no
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* If you answered “yes” to the last question, please explain here:
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* Have you ever been convicted, plead guilty or no contest, or forfeited bond or bail for any crime, other than for traffic violations?
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yes no
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* If you answered “yes” to the last question, please explain here:
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Please Note:
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(Conviction of a crime is not an automatic bar to employment. Factors such as the nature and gravity of the crime, the length of time that has passed since the conviction, and/or completion of any sentence and the nature of the job for which you have applied will be considered.)
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* Are you able to perform the primary duties of the job with or without reasonable accommodation?
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yes no
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* If you answered “no” to the last question, please explain here:
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Read the Following Carefully Before Signing
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I certify that I have answered the above questions truthfully and have not withheld any information relative to my application. I understand that any falsification, misrepresentation, or omission, as well as any misleading statements or omissions of the application information, attachments and supporting documents generally will result in denial of employment or immediate termination, if discovered after hire.
I authorize Whitehall to investigate whether I have a criminal record of convictions, and, if so, the nature of such convictions, and all surrounding circumstances of the conviction. Whitehall Boca has advised me that any criminal background check will focus on convictions, and that a criminal record will not necessarily disqualify me from employment.
If hired, I recognize the rules and policies of Whitehall Boca. I understand that my employment and compensation can be terminated at any time, with or without cause, and with or without notice, at the option of Whitehall Boca or myself. I understand that the Administrator is the only person who will ever have the authority to create any other terms of employment and/or to enter into any employment contract and that all such contracts must be in writing and signed by both parties. However, I also understand that unless otherwise stated in an employment contract, the company may change, withdraw and interpret other policies (including wages, hours, and working conditions) as it deems appropriate.
I understand and acknowledge that I may be required to submit to a physical examination, including drug test. Additionally, I hereby authorize the release of the results of such an examination to Whitehall Boca for their use in evaluating my suitability for employment. Further, I release the examining facility and Whitehall Boca from any and all liability, and from any damage that may result from the release of such information.
Furthermore, my signature below affirms that I am a non-smoker. I understand that as an employee of Whitehall Boca, I will maintain a non-smoking status and will adhere to Whitehall’s non-smoking policy. Violation of this affirmation may result in termination of employment.
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* I hereby acknowledge reading and understanding the foregoing statements:
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yes no
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My typed name below shall have the same force and effect as my written signature.
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* Applicant’s Signature:
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Today’s Date:
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Monday, May 18, 2026
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How Did You Learn About Whitehall Boca?
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Clear this form and start over, OR
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