Employment Application

BETTERLIVES LLC
141 N. Martinwood Rd. --- Suite 104-13 --- Knoxville, TN 37923

BetterLives is a drug free workplace

BetterLives LLC 141 N. Martinwood Road Knoxville, TN 37923 865-313-6355
Position Desired:
Date Available

MonthDayYear
Date
Part TimeFull Time
Date of Birth

MonthDayYear
Date
Name

First NameLast Name
MI
Address

Street Address

Street Address Line 2

CityState/Zip

Postal / Zip Code
Home Phone
Alternate Phone
E mail Address
example@example.com
YesNo
YesNo
Class:
State
License Number
Have you ever served in the military? Yes
Yes
No
Do you speak any other language(s)? Specify
NoYes
YesNo
If not, explain
YesNo
If yes, explain
Have you ever worked for
YesNo
If so, give date(s) of employment and position(s) held

MonthDayYear
Date
141 N. Martinwood Rd. --- Suite 104-13 --- Knoxville, TN 37923
YesNo
If Yes, State their name.
List any current licenses, certifications, or registrations required for the position for which you are applying.
YesNo If yes, written documentation must be provided about criminal offenses from the clerk of court in the county in which the conviction was made, and about any driving offenses other than minor traffic violations from the motor vehicles office.Have you ever been convicted of any criminal or driving offense(s) other than a minor traffic violation?
List any current licenses, certifications, or registrations required for the position for which you are applying. Include date received.
You must provide at least three current reference letters and/or the name of individuals with whom a reference interview can be conducted. Please give the full name, mailing address, and phone number of three references who have knowledge of your background and qualifications the field.
Please list three (3) references
High SchoolGEDAssociatesCollege 0-3 yearsBachelorsMasters
If degree, specify major
Software Applications
141 N. Martinwood Rd. --- Suite 104-13 --- Knoxville, TN 37923

You may attach a copy of your resume to this application; however we require that the

experience fields be completed on the application.

Experience List last 5 years of work experience
Beginning Salary
Ending Salary
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Name of Employer
YesNo
Address

Address

Street Address Line 2

CityState/Zip

Postal / Zip Code
Supervisor's Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Title and Duties Performed
Reason for Leaving
To

MonthDayYear
Date
From

MonthDayYear
Date
Beginning Salary
Ending Salary
Name of Employer
YesNo
Address

Address

Street Address Line 2

CityState/Zip

Postal / Zip Code
Supervisor's name
Phone Number
Format: (000) 000-0000.
Title and Duties Performed
Reason for Leaving
141 N. Martinwood Rd. --- Suite 104-13 --- Knoxville, TN 37923
From
To

MonthDayYear
Date
From

MonthDayYear
Date
Beginning Salary
Ending Salary
Name of Employer
YesNo
Address

Address

Street Address Line 2

CityState/Zip

Postal / Zip Code
Supervisor's Name
Phone Number
Title and Duties Performed
Reason for Leaving
I agree to carry out the designated responsibilities to the best of my ability. I have read the position description. I am aware there is a conditional period of 3 months prior to permanent employment. I certify that I have given true, accurate and complete information on this form to the best of my knowledge. I authorized investigation of statements made in this application and understand that false information may be grounds for denial of my position and/or dismissal if I am employed
Signature

Clear
DATE

MonthDayYear
Date
Should be Empty:

BETTERLIVES LLC