Ten Broeck Commons Employment Application
(Fields noted with an * are required) |
| Date |
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| Position Applied For |
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| Name* |
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| Address* |
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| Email |
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| Phone |
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Have you worked for
Ten Broeck Commons before? |
Yes No |
| If Yes, where and when? |
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EDUCATION |
| (Select Highest Grade Completed) |
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SCHOOL |
| Name of Last School Attended |
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| # Of Yrs. Attended |
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| Did You Graduate? |
Yes No |
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WORK EXPERIENCE (Please list last position first) |
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EMPLOYER 1 |
| Name |
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| Address |
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| Phone |
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| Salary |
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| Period of Employment From |
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| To |
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| Job Title |
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| Reason For Leaving |
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EMPLOYER 2 |
| Name |
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| Address |
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| Phone |
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| Salary |
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| Period of Employment From |
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| To |
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| Job Title |
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| Reason For Leaving |
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EMPLOYER 3 |
| Name |
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| Address |
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| Phone |
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| Salary |
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| Period of Employment From |
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| To |
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| Job Title |
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| Reason For Leaving |
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| Are you age 18 years or older? |
Yes No |
| If Under 18, Do You Have a Work Permit? |
Yes No |
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LICENSED PERSONNEL |
| STATE REGISTRATION NUMBER |
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| EXPIRATION DATE |
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| IF NO LICENSE, PERMIT NUMBER |
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| IS YOUR PROFESSIONAL LICENSE, OR WAS IT EVER UNDER PROBATION OR RESTRICTIONS OR ANY OTHER LIMITATIONS? |
Yes No |
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AGREEMENT - Please read and select the appropriate button below:
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I UNDERSTAND THAT ANY EMPLOYMENT WILL BE ON A SIX (6) MONTH INTRODUCTORY BASIS AND THAT MY EMPLOYMENT MAY BE TERMINATED WITH OR WITHOUT CAUSE OR NOTICE, AT ANY TIME, AT EITHER MY OPTION OR THAT OF THE COMPANY. I UNDERSTAND THAT NO MANAGEMENT REPRESENTATIVE HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR CONTINUING EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME OR WHICH IS CONTRARY TO THE FOREGOING WITHOUT WRITTEN APPROVAL OF THE COMPANY. I GIVE THE COMPANY PERMISSION TO CONTACT ALL OR ANY OF MY PREVIOUS EMPLOYERS, REFERENCES AND ANY INVESTIGATIVE AGENCY INCLUDING CREDIT OR CRIMINAL BACKGROUND CHECK AND AUTHORIZE THEM TO PROVIDE ALL INFORMATION REQUESTED OF THEM BY THE COMPANY. I RELEASE ALL PARTIES GIVING OR RECEIVING INFORMATION FROM ANY LIABILITY ASSOCIATED WITH DOING SO. AFTER A TENTATIVE OFFER OF EMPLOYMENT HAS BEEN MADE, IF REQUESTED BY THE COMPANY, I AGREE TO TAKE A JOB-RELATED MEDICAL EXAMINATION AT NO PERSONAL EXPENSE AND AUTHORIZE THE EXAMINING PHYSICIAN TO DISCLOSE THE FINDINGS TO THE COMPANY. I UNDERSTAND THAT ANY OFFER OF EMPLOYMENT IS CONDITIONED UPON RECEIPT OF SATISFACTORY REFERENCES AND SATISFACTORY COMPLETION OF SUCH JOB-RELATED MEDICAL EXAMINATION.
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I HAVE PROVIDED TRUTHFUL AND COMPLETE RESPONSES TO ALL INQUIRIES IN THE APPLICATION AND UNDERSTAND THAT THE DISCOVERY OF ANY FALSIFICATION OR OMISSION CONSTITUTES A GROUND FOR IMMEDIATE DISMISSAL. IF EMPLOYED, I WILL ABIDE BY COMPANY'S RULES AND REGULATIONS, WHICH I UNDERSTAND ARE SUBJECT TO CHANGE BY THE COMPANY.
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