Job Application Copy

JOB APPLICATION COPY

This document is a copy of the job application submitted to the prospective employer. Complete every applicable section clearly and accurately. False statements, omissions, or misrepresentations may be grounds for rejection of the application or termination of employment if discovered after hire.

Applicant Information

Phone:    Email:

Position and Availability

Date Available to Start:    Desired Salary:

Are you legally authorized to work in the jurisdiction where this position is located? Yes No

Have you previously worked for this company? Yes No    If yes, dates of employment:

Education

Employment History (Most Recent First)

Job Title:    From:    To:

Supervisor:    Phone:    May we contact? Yes No

Job Title:    From:    To:

Supervisor:    Phone:    May we contact? Yes No

References

Additional Information

Background Check Authorization & Certification

I certify that the information provided in this application is true, complete and correct to the best of my knowledge. I understand that any falsification, material omission, or misrepresentation may be grounds for refusal to hire or for immediate termination if discovered after hire. I authorize the prospective employer and its agents to verify all information provided, including but not limited to education, employment history, criminal history, and credit history where job-related and permitted by law.

I hereby release from liability any person, organization, or entity that provides information in good faith pursuant to this application, and I consent to the employer obtaining consumer reports and other background information as may be necessary to evaluate my suitability for employment, to the extent permitted by law.

Consent to background check: I consent I do not consent

If offered employment, do you agree to submit to job-related drug/alcohol testing where required? Yes No

At-Will Employment Acknowledgment

I acknowledge that, unless otherwise expressly agreed in a signed written agreement, employment with the prospective employer is on an at-will basis. This means that either the employer or I may terminate the employment relationship at any time, with or without cause and with or without notice, except as otherwise provided by applicable law.

Applicant Certification and Signature

By signing below I certify under penalty of perjury that the statements in this application and any attachments are true and complete. I understand that completion of this application does not guarantee an offer of employment.

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