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Employment Application

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APPLICANT INFORMATION

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Please type your street address.
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Please type the position you are applying for.
Please type your desired salary.
Please enter the date you are available to start.

Desired Hours/week Range:

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EDUCATION


High School

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Did you graduate?
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College

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Did you graduate?
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Other

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REFERENCES

Please list three (3) professional references:

Reference #1

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Reference #2

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Reference #3

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PREVIOUS EMPLOYMENT


Previous Employer #1

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Please enter the date you worked from.
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May we contact your previous supervisor?
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Previous Employer #2

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Previous Employer #3

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COMMENTS

This section is for your personal comments. Please feel free to list any honors, scholarships, achievements, memberships in professional,honorary and non professional societies and any other information you feel would be helpful to us in your evaluation. Exclude memberships that would reveal race, color, religion, creed, sexual orientation, national origin, citizenship, marital status, age, disability, veteran/reserve National Guard or any other similarly protected class.

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Have you ever been convicted of a crime?
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If yes, briefly describe circumstances to include date of conviction, nature, and place of offense, and disposition of case. This information is viewed as only one factor in your consideration of employment and is evaluated in terms of nature, severity and date of offense.

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TELL US ABOUT YOURSELF

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DISCLAIMER, ACKNOWLEDGMENT, AND SIGNATURE

  • I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.
  • I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause, to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employers service, whenever it is discovered.
  • I expressly authorize, without reservation, the employer, its representative, employees or agents to contact and obtain information from all references (personal and professional), employers public agents, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.
  • I understand that the employer does not unlawfully discriminate in employment and no questions on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.
  • I understand that this application remains on file for 12 months. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.
  • If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time with or without cause and without prior notice, except as may be required by law.
  • This application does not constitute an agreement or contract for employment for any specified period or definite duration.
  • I understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.
  • I hereby acknowledge that I have read and understand the foregoing.

Alsara Clinic an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

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