Employment Application Form

Employment Application

Fill the form below accurately indicating your potentials and suitability to job applying for.
Name

First NameLast Name
Position Desired:
Status Desired:
Birth Date

MonthDayYear
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Training and Certifications
Certification Number
Resume and Files

Cancelof
References

Please list two (2) references that are familiar with your work life that you have known for two (2) years.
Reference
Reference

1.) I understand and accept that, if I am selected for employment, my employment may be conditional upon my passing any medical examination that the employer deems necessary to determine whether I can physically perform the essential functions of the position, with resonable accommidation when necessary. I understand and accept that this may include drug, alcohol or substance abuse testing.

2.) I Understand and accept that if any information required in this application is found to be falsified or intentionally excluded, my application may be disqualified from futher consideration. I further understand and accept that if I am employed by the empoyer, I may be subject to disciplinary action, including termination, if any information required by this application has been falsified or intentionally excluded.

3.) I understand and accept that the employer requires a high degree of integrity and confidentiality of its employees. I also understand and accept that the various law enforcement and informational agencies that exchange information and data with the employer require that the employer's employees do not have a past record of unlawful activites. Therefore, I understand and accept that, depending on the department in which I am applying for employment, it may be neccessary for the employer to investigate my background for any criminal or unlawful activity.

4.) I hereby authorize the employers, schools and persoanl references named in this application to provide information regarding me to the employer. I further authorize the release of personnel, academic and other records to the employer.
I solemnly swear that all of the information furnished in this employment application is true, accurate and complete to the best of my knowledge. I authorize investigation of all statements contained in this application. I understand that any misrepresentation or falsification of the information provided may lead to withdrawl of an employment offer or termination following employment. I recognize that my future employment with this employer will be jeopardized if I engage in substance abuse, illegal drug use or alcohol abuse.
Signature
Should be Empty: