Applicant Information
Desired Hours
Education
Previous Employment (Please list three employers, starting with the last one first)
References (Please list three persons not related to you, whom you have known at least one year)
Please read carefully before signing. If you have any questions regarding the following statements, please ask for assistance. I hereby certify that the following statements, as well as those on any attachment(s) to this form, to the best of my knowledge are true and correct and that they are all given of my own free will. I agree that any misstatement(s) or omission(s) as to material facts will constitute grounds for unfavorable consideration or dismissal from employment.
I authorize you to communicate with all my former employers, schools, officials, and persons named as references. I hereby release all employers, schools and individuals from any liability for any damage whatsoever resulting from giving such information.
I understand that as this organization deems necessary, I may be required to work overtime hours or hours outside a normally defined work day or work week. If employed, I understand and agree that such employment may be terminated at any time and without any liability to me for continuation of salary, wages, or employment related benefits.
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An equal opportunity employer—discrimination in employement practices because of race, color, religion, sex, age, national origin or disability is prohibited.
