EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION
An Equal Opportunity Employer
Position applying for*
Location applying for*
Today’s Date*

MonthDayYear
Date
First Name*
Last Name*
Date of Birth(Optional)

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State*
Zip*
E-mail Address*
example@example.com
Phone*
Format: (000) 000-0000.
Are you authorized to work in the United States?*

YesNo
Are you at least 18 years old?*

YesNo
If hired, would you have a reliable means of transportation to and from work?*

NoYes
Desired employment Status & Schedule:
Are you seeking*

Full-timePart-timeFull-time or Part-time
Days available to work on a weekly set and repeating schedule (mark all that apply)*

Fully availableMon.Tues.Wed.Thurs.Fri.Sat.Sun.

Education*

Rows	Name of School	Completed Years	Major/Degree	Graduated Year (optional)
High School:
College:
Other:

Do you have any friends or relatives working for our Company?*

YesNo
If yes, state name(s) and relationship
Do you speak any languages other than English?*

YesNo
If yes, please list
If you are applying for a position that requires a license, are you licensed for the position?*

YesNo
License Number (if applicable)
Has your license/certification ever been suspended or revoked?*

YesNo
Employment / Work Experience
List below all present and past employment starting with your most recent employer.
Company
Address
Phone
Format: (000) 000-0000.
Job Title
From
To
Responsibilities
Reason for Leaving
May we contact this employer?

YesNo
Company
Address
Phone
Format: (000) 000-0000.
Job Title
From
To
Responsibilities
Reason for Leaving
May we contact this employer?

YesNo
Company
Address
Phone
Format: (000) 000-0000.
Job Title
From
To
Responsibilities
Reason for Leaving
May we contact this employer?

YesNo
Identify and explain all periods of unemployment during the past seven years.*
Please Read Carefully, Initial Each Paragraph and Sign Below*

I certify under penalty of perjury that my answers are true and complete to the best of my ledge, I have not knowingly withheld any information that might adversely affect my chances for employment. I further certify that I have personally completed this application. I understand that any omission or misstatement of fact on this application or on any document used to obtain employment will be grounds for rejection of this application or for immediate termination if I am employed, no matter when discovered.I authorize the Company to thoroughly investigate my work record, education, and othermatters related to my suitability for employment and, further, authorize my formeremployers that I have listed to disclose to the Company any and all letters, reports andother information related to my work records, without giving me notice of such disclosure.In addition, I release the Company, my former employers and all other persons, corporations,partnerships and associations from liability arising out of or in any way related to suchinvestigation or disclosureI understand that nothing contained in the application or conveyed during any interviewintended to create an employment contract between me and the Company. In addition, Iunderstand and agree that if I am employed, unless indicated in the employmentagreement and in writing, my employment is “at will”, for no definite time period andmay be terminated at any time, with or without notice, at the option of either myself orthe Company. Unless a written agreement exists, the employment is “at will”
Disclaimer and Signature
Your Name*
, hereby authorize New Look Skin Center to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. I understand that New Look Skin Center may utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company's choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for employment will not be processed further.
Applicant Name Printed*
Date*

MonthDayYear
Date
Signature of Applicant:*
Attach your resume here*

Cancelof
Should be Empty:

An Equal Opportunity Employer

Employment / Work Experience