(Please list employment in order beginning with most recent.)
Present or Last Employer
Previous Employer #1
Previous Employer #2
Previous Employer #3
(Please list 2-3 professional references and no more than one personal reference. Also, please do not list supervisors named In employment section.)
Special Purpose Questions
CERTIFICATION BY APPLICANT
(Please read carefully)
By submitting this online application form I certify that the information given on this application and in any other supporting documentation, resume, or interview is true and correct. I understand that any false information, willful or negligent misrepresentation, or failure to disclose any requested information constitutes sufficient grounds for THE PROGRAM to terminate my employment without notice. I further understand that THE PROGRAM will perform a pre-employment investigation to determine my suitability for employment and I authorize THE PROGRAM to secure the information necessary to make a decision.
I authorize all previous employers to furnish THE PROGRAM with any information that they may have regarding my employment and my reason for leaving, and I release my prior employers and THE PROGRAM from al liability for and damage resulting from the information provided. If employment results from this application, I understand that additional personal data or a physical examination may be required if I am offered a position.
I understand that THE PROGRAM will adhere to applicable state and federal statutes concerning the securing of information and the handling, utilization, and release of information obtained in the pre-employment investigation. I acknowledge by my signature that I have read and understand these statements.