Residency Job Application Form

Residency Job Application Form

Please complete all sections of this application accurately and sign the agreement at the end. Submission of this form authorizes the prospective Employer to verify information provided, including but not limited to employment history, education, licensure, and criminal background, where permitted by law. Incomplete applications may delay consideration.

Position Requested

Date of Application:   Available Start Date:

Applicant Information

Eligibility & Authorization

Are you legally authorized to work in the country where this residency is located? Yes No

Do you require sponsorship for employment visa status now or in the future? Yes No

By submitting this application, I authorize the Employer to investigate statements made on this application and to obtain verification of my prior employment, education, certifications, and criminal record where permitted by law. I understand that falsification or omission of facts may result in denial of employment or termination.

Education & Qualifications

Employment History (Most Recent First)

References

Background Questions

Have you ever been convicted of a felony or misdemeanor that has not been annulled, expunged, or sealed? Yes No

Availability

Typical availability (check all that apply): Weekdays Weekends Evenings/Nights On-call

Applicant Statement & Consent

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any misstatement or omission of facts may be grounds for refusal of employment or, if employed, for dismissal. I authorize the Employer to contact my references and prior employers and to obtain a background check as a condition of employment where permitted by law.

Conditional Employment Agreement (General Business Agreement)

This Conditional Employment Agreement (the "Agreement") is entered into between Employer Name: and Applicant Name:

WHEREAS, Employer operates a residency program and seeks to engage qualified personnel to perform services in connection with the residency; and

WHEREAS, Applicant has applied for employment and represents that Applicant possesses the qualifications and credentials required for the position; and

WHEREAS, the parties desire to set forth the terms and conditions under which Applicant may be employed by Employer on the terms set forth below.

Scope of Work

Payment Terms

Compensation Amount: $   Payment Schedule: Monthly Bi-weekly Per diem Other

Late Payment Fee: . Employer shall withhold applicable taxes and deductions as required by law.

Term and Termination

Term Start Date:   Term End Date (if applicable):

This Agreement is subject to an initial probationary period and may be terminated by either party for any reason upon written notice. Notice Period: days. Nothing in this Agreement shall be construed to create a guarantee of continued employment beyond the terms expressly set forth.

Confidentiality

Applicant acknowledges that, by virtue of the position, Applicant may have access to confidential, proprietary, or sensitive information concerning Employer, residents, clients, or business operations. Applicant agrees not to disclose such information during the term of employment or thereafter, except as required by law or with Employer's prior written consent. Applicant further agrees to return all Employer property and confidential materials upon termination.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to its conflict of laws principles.

Entire Agreement

This Agreement, together with any written attachments or schedules executed by the parties, constitutes the entire agreement between Employer and Applicant with respect to the subject matter hereof and supersedes all prior agreements, understandings, negotiations and discussions, whether oral or written. Any amendment to this Agreement must be in writing and signed by both parties.

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