APPLICATION FOR EMPLOYMENT

Transcription

1 APPLICATION FOR EMPLOYMENT It is AlphaMed Inc. s policy not to discriminate on the basis of age, sex, race, color, creed, national origin, marital status, pregnancy or any protected class as required by law. We Are an Equal Opportunity Employer RESUMES WILL NOT BE ACCEPTED IN LIEU OF ANY INFORMATION REQUIRED ON THIS APPLICATION. Last Name First Name Middle Initial Street Address City State Zip Code Home Phone Cell Phone Alternate Address Position / Type of Employment Requested: Position Full Time Part Time Hours and days available for work: Date available to begin Wage/Salary Expected Are you eligible to work in the U.S.? No Yes This employer uses E-Verify for all I-9 documentation. For more information visit Are you at least 18 years of age? No Yes Do you have any relatives employed by AlphaMed Inc.? (If so, please list names below) Language(s) spoken, written, or read other than English (please cite competency level): Page 1 of 5

2 Have you ever pled guilty, no contest, or been convicted of a crime? No Yes If yes, please explain EDUCATION AND TRAINING Please provide copies of any degrees, certifications, licenses, and military service records noted in this section. Attach to the end of this application. Formative Education High School Graduate or General Education Test passed? No Yes If no, circle the highest grade completed: Name and City/State of High School attended: College, Business School, Secondary Training, Etc. (Most recent first) School Name and Location Credits Earned (if no degree awarded) School Name and Location Credits Earned (if no degree awarded) School Name and Location Credits Earned (if no degree awarded) Page 2 of 5

3 Special Certifications, Licenses, Etc. Type of License, Certification, Number Where / State Issued Date of Issue Expiration Date Type of License, Certification, Number Where / State Issued Date of Issue Expiration Date Veteran / Military Service Information Branch of Service Date of Entry Date of Discharge Special Commendation (if applicable) Special Skills (List all pertinent job skills, strengths, and equipment/machinery you can operate) Personal Development (Explain below what training, involvement, and/or leadership position you hold or have held in a community organization that helps prepare you to stand out in AlphaSleep Lab) Attach additional documents if necessary. WORK EXPERIENCE & REFERENCES / ADDITIONAL INFORMATION (You may include all volunteer work and / or military experience as well, if you choose) It is the policy of AlphaMed, Inc. to do thorough research on every applicant. If you wish, we will not contact your current employer. List your 3 most recent employers, in descending chronological order Current / Most Recent Employer Began Working Here Employer's Address Phone ( ) - Starting Yearly Salary Current/Ending Yearly Salary Page 3 of 5

4 Immediate Supervisor's Name May we contact? No Yes Reason for leaving - Next Most Recent Employer Dates There Employer's Address Phone ( ) - - Starting Yearly Salary Current/Ending Yearly Salary Immediate Supervisor's Name May we contact? No Yes Reason for leaving - Next Most Recent Employer Dates There Employer's Address Phone ( ) - - Starting Yearly Salary Current/Ending Yearly Salary Immediate Supervisor's Name May we contact? No Yes Reason for leaving Next List 3 Non-Family References; 2 business, 1 personal Business Reference: Name: Years known: Please cite Business Relationship with this Reference: Personal Reference 1: Name: Years known: Personal Reference 2: Page 4 of 5

5 Name: Years known: Additional Information Please use this section below to share any pertinent information you wish to share at this time regarding your work history, training, present situation and goals regarding this position for which you are applying. This is completely voluntary and will in no way affect the consideration for hire. ATTESTATION & SIGNATURE I attest that all statements in this application are true and correct. I understand that false information revealed may be cause for dismissal if hired and will be cause for immediate disqualification in the application process. Employment here is a voluntary one and is subject to termination by you or AlphaSleep Labs, at will, with or without cause, and with or without notice, at any time. Nothing in this application shall be interpreted to be in conflict with or to eliminate or modify in any way the employment-at-will status of AlphaMed Inc. employees. Signature of Applicant Date Page 5 of 5