Form La Ocdd-Ccw - Employment Application (Page 2 of 2) in pdf

LIST PREVIOUS JOBS YOU HAVE HAD (BEGINNING WITH MOST RECENT):

EMPLOYER’S NAME:

DATES OF EMPLOYMENT:

EMPLOYER’S ADDRESS:

SUPERVISOR’S NAME:

PHONE NUMBER:

LIST OF JOB DUTIES:

REASON FOR LEAVING:

EMPLOYER’S NAME:

DATES OF EMPLOYMENT:

EMPLOYER’S ADDRESS:

SUPERVISOR’S NAME:

PHONE NUMBER:

LIST OF JOB DUTIES:

REASON FOR LEAVING:

EMPLOYER’S NAME:

DATES OF EMPLOYMENT:

EMPLOYER’S ADDRESS:

SUPERVISOR’S NAME:

PHONE NUMBER:

LIST OF JOB DUTIES:

REASON FOR LEAVING:

BRIEFLY LIST REASONS YOU SHOULD BE CONSIDERED FOR THIS JOB:

APPLICANT ACKNOWLEDGEMENT

You ___may ____may not contact my current employer. If not, reason:

If offered a position, will you be able to be at work on time and according to the schedule discussed? __ Yes ___ No

Comments:

I, ____________________________(print name), the applicant certify that the information provided is true and correct to

the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is

sufficient cause for refusal to hire, or dismissal if employer has employed me, no matter when discovered by employer. I

also acknowledge that a criminal background history check is required and that some convictions prevent employment. I

also acknowledge that I may be required to keep certain certifications current and may be required to complete additional

training as a condition of my employment.

I authorize this potential employer to investigate all statements contained in this application, and I authorize my former

employers and references to disclose information regarding my former employment, character and general reputation,

without giving me prior notice of such disclosure.

I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create

an employment contract. I further understand and agree that if I am hired, my employment will be “at will” and without

fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself

or this employer. No promises regarding employment have been made to me, and I understand that no such promise or

guarantee is binding upon this employer unless made in writing.

Signature:

Date:

LA OCDD-CCW

Rev. 02/12/14

Form La Ocdd-Ccw - Employment Application Page 2

Related Articles

Related forms

Related Categories