APPLICATION FOR EMPLOYMENT

Transcription

1 APPLCAO FO MPLOYM ame First Middle Date P O A L treet City, tate, Zip Have you ever applied for employment with us? f yes: Month and Year Location Position Desired Hours Desired Part ime Full ime ime Are you legally eligible for employment in the United tates? Home Business ocial ecurity # Pay xpected Will you work overtime if asked? When will you be able to begin work? Other special training or skills (languages, computer operation, etc.) Membership in Professional or Civic Organizations (You may exclude those which disclose your race, color, religion or national origin)

2 chool ame and Location of chool Course of tudy Years Attended Did you graduate? Degree or Diploma Graduate D U C A O College Business / rade / echnical High chool lementary Certifications / License

3 mployment (please do not refer to resume) 1 ame of upervisor tate Job itle and Describe Your Work mployed (tate Month and Year) eason for Leaving 2 ame of upervisor tate Job itle and Describe Your Work mployed (tate Month and Year) eason for Leaving 3 ame of upervisor tate Job itle and Describe Your Work mployed (tate Month and Year) eason for Leaving 4 ame of upervisor tate Job itle and Describe Your Work mployed (tate Month and Year) eason for Leaving We may contact the employers listed above unless you indicate those you do not want us to contact. mployer Do t Contact eason

4 Applicant tatement (please read before signing) understand that this employer follows an employment at will policy, in that or the employer may terminate my employment at any time, or for any reason consistent with applicable state or federal law; this employment at will policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by the chief executive officer of this organization. understand that this application is not a contract of employment. understand that federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity; failure to submit such proof will result in denial of employment. understand that the employer will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. authorize all individuals, schools, and firms named therein, except my current employer if so noted, to provide any information requested about me, and release them from all liability for damage in providing this information. certify that the information provided in this Application for mployment is true, correct and complete. Any falsification or willful omission on this application shall be sufficient cause for dismissal or refusal of employment. understand that if accept the position offered, ummit Cancer Care would request a criminal history information report from all applicable agencies. he results of this report may affect my continued employment. understand that acceptance of an offer of employment creates no obligation upon you, the employer, to continue to employ me in the future. Date ignature

5 FO MPLOY U OLY F C Person Contacted Phone # esults V W U L nterviewer ame and Comments Offer Made: Date Offer Made: alary Offered Date Accepted or Declined: