Type of work desired - Please rank in order of preference, or mark N/A for "not applicable".
Instructions: List your last four previous employers below, starting with your most recent employer. Explain any gaps in employment at the end of the page. All information MUST be completed.
Explain gaps in employment longer than 30 days.
Instructions: List four references you have known for at least one year. Do not list persons related to you or persons already listed in the Employment Section.
Read the following information carefully before submitting below.
I hereby affirm that the information provided on this application is true and complete. I understand that any false or misleading representations or omissions made on the application or during the hiring process may disqualify me from further consideration for employment and may result in discharge even if discovered at a later date. I understand that employment may be conditioned upon successfully passing a medical examination and that I will be required to satisfactory complete a drug screening, physical assessment and TB screening as a condition of employment. I hereby authorize persons, schools, my current employer(if applicable) and previous employers and other organizations to provide this facility and its affiliates with any requested information regarding my application or suitability for employment, and I completely release all such persons or entities from any and all liability related to the providing or use of such information. I understand that my employment is at-will which means that I may terminate the employment relationship at any time and for any reason with or without notice, and that the facility has the same right. I understand that no one has the authority to enter into any agreement contrary to the preceding sentence, except for a written agreement signed by an administrative representative of this facility and notarized.