Date of Application
Date Available
Location:
Privacy statement
The company is committed to the principles of Equal Employment Opportunity. The Company
believes its continued success depends on the full and effective utilization of qualified
persons regardless of race, color, creed, religion, national origin, sex, age, disability,
marital status, veteran status, sexual preference, status with regard to public assistance,
familial status, genetic information, or other classification protected by law. All recruiting,
hiring, training, compensation, benefits, transfers, promotions, social or recreational programs,
and on-the-job treatment are to be administered in accordance with this commitment.
I voluntarily give this institution the right to make a thorough investigation of my past
employment and activities, agree to cooperate in such investigation and release from all
liability or responsibility all persons, companies or corporations supplying such information.
I consent to take the physical examination and such future physical examinations as may be
required by this institution at such times and places as the institution shall designate.
I understand than offer of employment may be contingent on passing the physician examination
which relates to the essential duties I would be required to perform.
I understand that my employment is at will and that either party is free to terminate the
employment relationship at any time without cause. I also understand that my employment
may be terminated for any misstatement or omission of fact appearing on this application form.
If employed, I will be required to complete an Employment Verification From (I-9) and within
three days show satisfactory evidence of identity and eligibility for employment.
I have read and affirm as my own the above statements.
Personal Information
Employment Desired
Position(s) applied for
Will you accept employment of:
Are you 18 years of age or older?
Education
Highest grade completed:
Professional Licenses and/or Certifications
Employment Record (list last or present position first)
or present position first)
or present position first)
Personal References (Do not include Relatives or Former Employers)
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Signature of Applicant