Note: The policy of this agency to provide every individual a fair and equal opportunity to seek employment and advancement at the agency without regard to race, color, religion, sex, age, national origin, citizenship status, veteran status, disability or factors protected by state or local laws. "An Equal opportunity Employment Act".
List names and addresses of all former employers, beginning with the most recent. (Send additional sheet to firstname.lastname@example.org if necessary)
I understand that the information on this application will be used and that prior employers will be contacted for the purpose of investigation.
Please read carefully before signing
I certify that any information I give during the course of applying for employment is true and complete. I understand that any false, incorrect or misleading information or the omission of any pertinent information including that given at the time my application may be considered as sufficient reason for my discharge, if hired. I further understand that this application is not intended to be a contract of employment and that, if I am hired, my employment is at will and can be terminated by either me or the agency, with or without notice, for any or no reason. No supervisor or manager has authority to make an agreement to the contrary changing employment at will. This application will be in effect for 90 days from the date indicated below and, if employment is not offered within the 90-day period, I understand that I must reapply to be considered for future employment. I also understand that this application for employment in no way obligates the agency to employ me.
I hereby authorize ALTA HEALTHCARE SERVICES to investigate my former employment and other references and to make any further investigations deemed necessary in connection with my application for employment and I do hereby release ALTA HEALTHCARE SERVICES and all informants of all liability whatsoever resulting from such investigations.
I understand that an offer of employment I may receive is subject to my subsequent completion, satisfactory to the agency, of all pre-employment procedures, including a drug and alcohol screen test, and submission of documents establishing my rights to work in the USA.