Job Nomination Application

JOB NOMINATION APPLICATION

Personal Information

Phone:    Email:

Employee ID (if applicable):    Current Title:

Current Supervisor/Manager:    Date of Hire:

Nomination Details

Proposed Department:    Proposed Supervisor:

Proposed Start Date:    Proposed Salary (if applicable):

Nominator Title:    Nominator Department:

Supporting materials attached: Resume/CV    Performance Reviews    Other

Qualifications & Justification

Employment History (Most Recent First)

Title:    Start Date:    End Date:

Title:    Start Date:    End Date:

Education

Institution:    Graduation Date:

Professional References (Three Required)

Phone:    Email:

Phone:    Email:

Phone:    Email:

Legal Disclosures & Authorizations

At-Will Employment: Submission of this Job Nomination Application does not constitute an offer of employment. If hired or reassigned, employment status will be at-will unless a written agreement signed by an authorized representative states otherwise.

Equal Opportunity: The organization provides equal employment opportunity to all applicants and employees without regard to race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable law.

Applicant Certification and Authorization: I certify that the information provided in this Job Nomination Application is true, complete, and correct to the best of my knowledge. I understand that material misrepresentation or omission may be cause for rejection of my nomination or termination of employment if discovered at a later date. I authorize the organization and its agents to contact my current and previous employers, educational institutions, and listed references to verify the information supplied and to obtain additional information concerning my suitability for the nominated position. I also authorize any such persons or entities to provide such information and release them from liability for providing truthful information in response to such inquiries.

Background Checks and Drug Testing: I understand that selection for certain positions may be contingent upon satisfactory completion of background checks, reference checks, employment verification, and/or drug testing where permitted by law. I consent to such inquiries and testing as a condition of consideration for this nomination.

Data Privacy: Information provided in this form will be used for employment consideration and internal personnel processes. Access to this information will be limited to authorized personnel on a need-to-know basis.

Acknowledgement of Accuracy: I certify that all statements in this application are true and complete.

Authorization to Contact: I authorize the organization to contact my previous employers and references as described above.

Applicant Statement

Sign Now