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Position(s) applying for:
Have you ever been employed with any of the following facilities:
Please complete employment history even if resume is attached. List your employment history starting with your most recent job. Please attach a separate sheet of paper for additional employment.
Explain any lapses in employment (other than military service):
List any other skills you possess:
- List (3) three Business References
Please include any other information you think would be helpful to us in considering you for employment.
(You may exclude all information indicative of age, sex, religion, race, national origin or handicap).
I hereby affirm that the information on this application (and resume, if any) is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I understand that my employment can be terminated, with or without cause, at any time at the discretion of the employer or myself. I understand that no management official other than the Chief Operating Officer of the employer has any authority or enter into agreement contrary to the foregoing or to make any oral assurance or promise of continued employment to me. I authorize persons, schools, my current employer (if applicable), and previous employers and organizations named in this application (and resume, if any) to provide any relevant information that may be required to arrive at an employment decision.