Have you ever applied for employment with this Agency? YES NO How many hours a week are you available for work? Are you legally eligible for employment in the United States? YES NO How did you learn of our organization?Google Website Other Are you willing to work: Evenings Weekends Position applying for:
1. Company Name: * Telephone: Address: , , Dates of Employment: Starting Pay: Ending Pay: Job Title and Describe Work Completed: Reason for leaving:
2. Company Name: Telephone: Address: , , Dates of Employment: Starting Pay: Ending Pay: Job Title and Describe Work Completed: Reason for leaving:
3. Company Name: Telephone: Address: , , Dates of Employment: Starting Pay: Ending Pay: Job Title and Describe Work Completed: Reason for leaving:
Was your last name different from your present name during the above listed jobs?YES NO If yes, what was your name? Are you currently employed? YES NO Do you have reliable transportation / the ability to reach multiple clients? YES NO
1. Reference Full Name * Phone * City * State * If Professional Reference: Position Held 2. Reference Full Name * Phone * City * State * If Professional Reference: Position Held
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand, that, if employed, falsified statements on this application SHALL BE GROUNDS FOR DISMISSAL.
I, * authorize complete investigation of all statements contained herein and herby give my full permission for the Agency to contact and fully discuss my background and history with all persons and entities listed above to give the Agency all information concerning my previous employment and any information they may have, and release all former employees and others listed above from all liability for any damage that my result from furnishing the same to the Agency.
I understand and agree that, if hired, my employment is for no definite period arid may, regardless of the date of payment of my wages and salary, be terminated at any time for any lawful reason, without prior notice and with or without cause.
This application for employment shall be considered active for a period not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time shall inquire as to whether or not applications are being accepted at that time