• Employment Application

    Apply now!

  • Thank you for applying for this position! We appreciate your time to complete this application and the Pre-Interview Questions that follow the application.

  • Are you at least 18 years of age or older?
  • How did you hear about our job opening?*
  • What days of the week are you available to work?
  • Upload a File
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  • Employment History Information

  • Please provide us with the details of your last three jobs.

    • Current or Most Recent Employer 
    • Start date
       - -
    • End date (if you are still employed, leave blank)
       - -
    • If you are still employed, please let us know what you prefer:
    • Next Employer 
    • Start date
       - -
    • End date (if you are still employed, leave blank)
       - -
    • Third Employer 
    • Start date
       - -
    • End date (if you are still employed, leave blank)
       - -

  • Personal References

  • If you like, you can include two personal references, such as teachers, coaches or religious leaders, who are familiar with your ability to work.

    • First Reference 
    • Second Reference 

  • Education

    • High School 
    • Did you graduate?
    • College 
    • Did you graduate?
    • Other Education 
    • Did you graduate?

  • Legal Agreements

  • 1. The information in this application is true. I authorize you to investigate all of the statements in this application. I understand that if I am hired, and any statements in this application are found to be false, I will be dismissed from employment.*
  • 2. I understand and agree that if accepted for employment it will be for no definite period of time or pay. Regardless of the date of payment of my wages or salary, I may be terminated at any time without any previous notification, also known as "at-will employment." This means I or my employer may terminate my employment at will. No one other than the owner of this business has the authority to alter this arrangement, to form an agreement for employment for a specified period of time, or to make any agreement contrary to this policy. Any change to this policy must be in writing and signed by the owner of this business.*
  • 3. I can and will provide documents proving my legal right to work in the United States prior to beginning employment.*
  • 4. I give permission for you or your agent to investigate my background which may include checking my employment history, driving record, credit history, education records, personal character references and any public records, as allowed by law. I authorize, without reservation, any law enforcement agency, state agency, information service company, public or private institution, or past employer to provide you with any information they may have regarding my background, as allowed by law. I authorize you and my former employers to openly discuss the information contained in this application and my past employment history.*
  • 5. I agree to being tested for illegal drug use both before and at any time during employment. If I refuse to take a drug-use test, or if the test shows I use illegal drugs, I understand I will be disqualified for the job.*

  • By typing my name and signing below, I acknowledge and agree that I am signing this Job Application as if actually signing it in writing.

  • Date*
     - -

  • Pre-interview Questions

  • Feel free to skip any questions you would rather not answer, but please try to answer most of them. Also, there are no wrong answers! Your extra time is greatly appreciated.

  • How is your personal credit history?
  • Which do you prefer? A position where you need to make decisions, a position where you follow written procedures or a position that includes a mixture of both?
  • How often do you exercise?
  • Do you ever do volunteer work or donate your time?
  • Is your job performance above average, average or below average?
  • How do you feel about supervising others?

  • Please click "Submit" and your application will be forwarded to our practice. If you wish to print a copy of your Job Application, click "Print Form" before you click "Submit."

    Thank you very much!

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