Employment Application
16797
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Employment Application

  • Personal Information:

  • PhoneAlternate Phone
  • Position Sought:

  • Wage/Salary ExpectedOn what date will you be available for work?
  • General Information:

  • Federal law requires applicants to present certain documentation to verify their identity and United States status or their legal authorization to work in the United States.
  • Education:

  • HIGH SCHOOL
  • Location (City + State)Last Completed Year
  • Major Course of StudyGraduated/Degrees
  • COLLEGE
  • Location (City + State)Last Completed Year
  • Major Course of StudyGraduated/Degrees
  • GRADUATE
  • Location (City + State)Last Completed Year
  • Major Course of StudyGraduated/Degrees
  • BUSINESS, TRADE or APPRENTICE
  • Location (City + State)Last Completed Year
  • Major Course of StudyGraduated/Degrees
  • Professional Certificates:

  • Type of LicenseLicense #Issuing StateExpiration Date 
  • References:

  • Please list three references who are NOT related to you.

  • NameAddressCity/State/ZipPhoneRelationship
  • NameAddressCity/State/ZipPhoneRelationship
  • NameAddressCity/State/ZipPhoneRelationship
  • Employment History:

  • Starting with your present or most recent job, list your employment experience. You may include job related military service assignments and volunteer activities that reflect your qualification for employment.

  • Company Name 1Mailing AddressPhone Number
  • Job TitleName of Supervisor
  • From:To:
  • Start:End:
  • Company Name 2Mailing AddressPhone Number
  • Job TitleName of Supervisor
  • From:To:
  • Start:End:
  • Company Name 3Mailing AddressPhone Number
  • Job TitleName of Supervisor
  • From:To:
  • Start:End:
  • Applicant's Statement:

  • I authorize investigation of all statements contained in the application for employment as may be necessary in arriving at an employment decision. I understand that an investigation may be made and information may be obtained through interviews with the personal references and past employers listed. I further understand any conditional offer of employment will involve obtaining a criminal background report, pre-employment drug screen, and/or driver license verification. I hereby authorize the organization, if they wish, to make such inquiries.

  • I hereby release all parties, personal references, and previous employers from any and all liability for any injury or damage that may result from their furnishing information to our organization concerning me or any action that we take on the basis of such information.

  • I understand that a physical examination may be required after an employment offer is made, with a report submitted, to be eligible for employment at Edgewater Place.

  • I understand that this application is not a contract of employment and that any resulting employment relationship is for no fixed period of time and is terminable at any time and for any reason by this organization, or by me. I further understand that statements which may be contained in policies, practices, handbooks or other material do not create any guarantee of employment and that this organization has the right to modify, amend, or terminate policies, practices, benefits plans, or other programs within the limits and requirements imposed by law. I understand that no representative of this organization, other than a corporate officer, has the authority to enter into any agreement for any specific period of time or to make any agreement contrary to the foregoing and that any such agreement must be in writing, signed by an authorized officer, and be specifically for employment, to be binding on the organization.

  • I certify that this application was completed by me and that all entries on it and all information contained in (this application, resume, and any supplement thereof) is CORRECT and COMPLETE to best of my knowledge. In the event of employment, I understand that false, misleading, or omitted information given in my application (or during interviews) may result in termination.

  • DateSignature of Applicant

    This information will be considered active for 6 months and retained for 12 months.

  • Edgewater Place Applicant Release Form

  • As an applicant for employment, I authorize Edgewater Place to confirm by personal inquiry information related to past employment, education or other applicable history, and releases from all liability or responsibility all persons, companies, or organizations responding to such inquiries. I understand that I will be subject to a background check.

  • Applicant NameDate