Employment Application

Education
High School *
Did you graduate? *

Yes No
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Diploma *

General Ed GED Not Applicable
College
Did you graduate? *

Yes No
Degree
From
month/year
To
month/year
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Professional References
Name

First Name Last Name
Company
Relationship
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Name

First Name Last Name
Company
Relationship
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Name

First Name Last Name
Relationship
Company
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Previous Employment
Company
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Responsibilities
From
month/year
To
month/year
Reason for Leaving
May we contact your supervisor for a reference?

Yes No
Supervisor Name

First Name Last Name
Company
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Responsibilities
From
month/year
To
month/year
Reason for Leaving
May we contact your supervisor for a reference?

Yes No
Supervisor Name

First Name Last Name
Company
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Responsibilities
From
month/year
To
month/year
Reason for Leaving
May we contact your supervisor for a reference?

Yes No
Supervisor Name

First Name Last Name

Additional Information
Would you like to provide additional references or work experience? Please use the following link to upload a .pdf, .doc, or .docx document with the supportive information.

Upload a File

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Code of Conduct
If chosen for employment, I agree to sign and adhere to the TLC Code of Conduct.

Yes No
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that any intentional misrepresentation or material omission made by me on this application may constitute grounds for rescinding a job offer or immediate termination of employment if I am employed, without notice. If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I, or the employer, can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law. I understand that this is a drug free workplace and consent to compliance with this policy as a condition of employment. I also understand that, if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization. Failure to submit such proof within the required time shall result in immediate termination of employment. I have read and fully understand the foregoing statements and I seek employment under these conditions.
*

I agree, I have read and understand the above statement.
Administrative Notes
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Transitions Life Center and Community, Inc.

Applicant Information

Education

Professional References

Previous Employment

Additional Information

Code of Conduct

Disclaimer and Signature