Employment Application Form

Employment Application

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

First NameLast Name
Birth Date*

MonthDayYear
Phone Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have DEPENDABLE transportation?*

YesNo
Are you at least 18 years or older?*
Employee Hours?*

Full timePart timeTemporary
Date available to start? blanks*
Have you previously applied at this company? blanks* . If yes, when did you apply? blank .
Are you a U.S. citizen? blanks* .(Must provide proof)
If no, does your immigration status permit you to work in the U.S.? blank (Proof must be provided)
Education
High School blanks Did you graduate? blank
College/Other blanksDid you graduate? blank
References

Please list two (2) references that are familiar with your work life.
Reference*
Reference*
Employee Work History*
Employee Work History
(PLEASE READ CAREFULLY BEFORE SIGNING)

All of the information that I have given to PSL in sonsidering me to be an employee is correct. I authorize the investigation of all matters concerning my consideration to be an employee. This investigation may include a criminal background search. I waive any right to prior written notice and authorize my former employers, references, and acquaintances to give any such information they have regarding me. I release and indemnify this employer, as well as any parties from whom information is obtained, from liability whatsoever resulting from the investigation and release of this information. If any ifnformation I have given to PSL is un-true or if I have concealed any information, I understand that this may result in denial of my employment and or termination of my employment with Parishes Supportive Living, Inc.
Signature*

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