Employee Form Document

EMPLOYEE FORM DOCUMENT

Employer Name:   Location:

Personal Information

Phone:   Email:

Date of Birth:   Social Security Number:

Position Information

Reporting Manager:   Proposed Start Date:

Full-time    Part-time    Temporary    Intern

Salary / Rate:   Pay Frequency: Hourly Weekly Bi-weekly Monthly

Employment History

Employer 1

From:   To:

Employer 2

From:   To:

Education

Graduation Date:

Professional References (3 required)

Reference 1

Phone:   Email:   Relationship:

Reference 2

Phone:   Email:   Relationship:

Reference 3

Phone:   Email:   Relationship:

Legal Disclosures and Acknowledgements

At-Will Employment: I acknowledge and understand that, unless otherwise agreed in a separate written contract signed by an authorized representative of the employer, my employment is at-will. Either I or the employer may terminate the employment relationship at any time, with or without cause or notice.

Equal Employment Opportunity: The employer is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, genetic information, or any other characteristic protected by applicable law.

I acknowledge and agree to the At-Will Employment statement above.

I acknowledge receipt of the Equal Employment Opportunity statement above.

Applicant Certification and Authorizations

Certification: I certify that all information provided in this Employee Form Document is true, correct, and complete to the best of my knowledge. I understand that misrepresentation, falsification, or omission of material facts on this form may result in refusal of employment or, if employed, disciplinary action up to and including termination.

Authorization to Contact: I authorize the employer and its agents to contact my previous employers, educational institutions, and listed references to verify information. I further authorize any such individuals or organizations to provide truthful information and release them and the employer from liability for providing such information.

Background Checks and Drug Testing: I understand that the employer may require a criminal background check, consumer report, and/or drug screening as a condition of employment. I consent to such checks and testing where permitted by law and authorize release of results to the employer for employment purposes.

I certify that the information provided is true and grant the authorizations described above.

I consent to background checks and drug testing as described above.

Additional Information

Relationship:   Phone:

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