TRLS Job Application Form

Full Name*

First NameLast Name

Social Security Number

Phone Number*

Birth Date

MonthDayYear

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Past Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you 18 years or older*

YesNo

Email Address*

Confirmation Emailexample@example.com

Note: TRLS will take social media accounts into consideration

Available Start Date*

Date

Have you worked at TRLS before?*

YesNo

If yes, please give date and position:

Do you have friends or family that have worked here?*

YesNo

If yes, please list name and relationship:

Position Applying*

Where did you first see this job posting?*

Employment History

	Past Employer Name & Contact Info	Dates Worked From / To	Salary	Position	Supervisor Name	Reason for Leaving
1.
2.
3.
4.
5.

Education History

	School Name and Location	Years Completed	Degree	Study or Major
High School
College
Graduate/ Proffesional
Trade/ Correspondence
Other

Personal References (no relatives)

	Name	Relationship	Company	Position	Telephone	Email (if needed)
1.
2.
3.
4.

REQUIRED Upload Your Resume and Cover Letter:

This application will be considered active for a maximum of thirty (30) days. If you wish to be considered for employment after that time, you must reapply.*

I HEREBY CERTIFY that all of the information that I have provided in this application is true and accurate.

Signature*

Application Statement and Agreement By signing and submitting this application, you are agreeing to the following. If there is anything that you do not understand please ask.

- I hereby authorize TRLS to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize all prior employers and references I have listed to disclose to TRLS and all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release TRLS, my former employers, and all other persons, corporations, partnerships, and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure.

- In the event of my employment with TRLS, I understand that I am required to comply with all rules and regulations of TRLS.

- If hired, I understand and agree that my employment with TRLS is at will and that neither I nor TRLS is required to continue the employment relationship for any specific term. I further understand that TRLS or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status or my employment cannot be amended, modified, or altered in any way by oral modifications.

- I understand that the safety of employees is extremely important to TRLS and that TRLS is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.

- I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

- I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration law requires me to complete an I-9 Form in this regard.

- I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable.

My signature attests that I have read, understand and agree to all of the above terms.

Three Rivers Legal Services Job Application