Personal Data
(If you have any question as to what functions are applicable to the position for which you are applying, please ask for a detailed job description before you answer this question.)
Availablity
(If employed, I will notify my supervisor in writing, should my availability change.)
Employment History
(Please list most recent employer first.)
Employment History
(Please list most recent employer first.)
Employment History
(Please list most recent employer first.)
Account for any full month since leaving school (high school or college) that you were not working
Education
(Omit any which reflects your race, color, religion, age, sex, sexual orientation, marital status or disabilities.)
Other Information
Professional/Business References
(If not applicable, Personal References)
Read Carefully Before Signing
- I hereby certify that all of the information provided in this application(or any other accompanying or required documents) is accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.
- I authorize without reservation my former employers, other persons or organizations to verify the accuracy of all information provided in this application, resume or job interview. I release all parties involved from any and all liability for any and all damages that may result from providing such information.
- I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by ReGenesis Health Care that such employment is at will, for no specific duration and may be terminated by either ReGenesis Health Care or myself at any time, with or without notice.
- I understand that if offered a position, I will be required to authorize a check of criminal conviction record, prior rights violation, motor vehicle records, and education and must submit proof of employment eligibility required by the Department of Homeland Security/U.S. Citizenship and Immigration Services.
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By signing below, I ACKNOWLEDE THAT I HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE STATEMENTS.
