Fillable Application For Employment (Page 3 of 4) in pdf

Employer 4

Employed

Supervisor’s Name/Job Title: _______________

From __________ Mo./Yr.

___________________________________

Address

May we contact:

Yes

Telephone

To ____________ Mo./Yr.

Your Job Title: ________________________

Your Salary

Duties:

Start

End

Reason for Leaving:

_____________________________________________________________________________________________________

If unemployed at any time, please describe reasons for unemployment. ___________________________________________

___________________________________________________________________________________________

Have you ever been discharged or forced to resign for misconduct or unsatisfactory performance?

Yes

If yes, please give details ________________________________________________________________________

___________________________________________________________________________________________

Membership in Organization/Professional groups which, in your opinion, have a direct bearing on the position you are seeking.

___________________________________________________________________________________________

Give any additional information which you feel may be helpful to us in considering your application. _____________________

___________________________________________________________________________________________

PLEASE READ AND SIGN STATEMENTS BELOW

I understand that, in a ccordance with Florida Statute 443.131(3)(a)(2)if hired, I will be placed on a 18 0-day probationary

period. I further un derstand that if I am terminated for unsati sfactory work performance within the 180-day probationary

period, the employer may seek to contest any unemployment benefit I might attempt to obtain as a re sult of my termination.

_____ (initials).

I understand and agree that all policies, procedures, and the Employee Handbook may be modified, amended, or deleted by

the Company with or without notice to me of such amendment, modification or deletion, that the policies and procedures are

not intended to be a contract of employment nor do they give me a ny right of contin ued employment; and th at my

employment may be terminated at my option or at the option of this Co mpany with or without notice by either party. I also

understand that there are no other arrangements, agreements, or understanding regarding the terms of employment. There

may be no amendments or exceptions to this statement unless they are in writing. ______ (initials).

I certify that all information given on this employment application, any resume that I submit to the Company, and any related

employment papers and answers given during oral interviews are true and correct. I un derstand that this Company may

make a thorough investigation of my work and personal history. I authorize the giving and receiving of any such information

requested by this Company during the course of such an investigation.

I understand that if any information I have

submitted is discovered to be false, I may be di squalified for employment and, if alre ady employed, I may be subject to

immediate dismissal. I hereby release from liability all persons who provide information to my employer during the course of

any such investigation. ______ (initials).

I expressly authorize, without reservation, the employer, its re presentatives, employees or agents to contact and obtain

information from all

references (personal and professional), employers, public agencies, licensing authorities and

educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or

job interview. I hereby wa ive any and a ll rights and claims I may have rega rding the employer, its agents, employee s or

representatives, for seeking, gathering and using such information in the employment process and all other persons,

corporation or organizations for furnishing such information about me ______ (initials).

Application For Employment Page 3

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