Application For Employment

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Employer

Telephone

Address

Street Address

Job Title

Supervisor

Reason for Leaving

Dates Employed: From

Work Performed

May we contact this employer:

Yes

If no, why?

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Special Skills & Qualifications

References

References (individuals willing to provide professional and/or character references, other than family and relatives).

Name

First

Telephone

Address

Street Address

Known How Long?

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Authorize(Required)

I authorize investigation of all statements contained in this application. I understand that falsification, omission, or misrepresentation of any fact called for in this application or during the application process will result in immediate termination or removal of my application from consideration. I authorize Employer to obtain information about my experience from the employers and references listed in this application and I release those parties from any liability that might arise from supplying information in response to a request from Employer.

Employer regulations(Required)

If I am employed by Employer, I agree to conform to the rules and regulations of Employer. I also agree and understand that wages, hours, and working conditions are subject to change by Employer, at any time with or without notice. I understand that, if hired, my employment with Employer would be “at will,” which means that it can be terminated at any time, with or without reason or notice by Employer, or myself. I understand that only an owner of Employer has the authority to enter into any agreement other than for at-will employment, and then only in writing. I understand that this application is not a contract of employment (express or implied) with Employer.

Agree(Required)

I agree to submit to any post-offer, pre-employment testing or physicals, including drug screening, as required by Employer.

Certify(Required)

I certify that I have read and I understand the foregoing. I also certify that, to the best of my knowledge, all of the information contained herein is true and correct

(Please note that Employer considers applications for 60 days. If you wish to be considered after 60 days, please reapply.)

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Educational Record

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References

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