State the employer's name, time spent at each employer, salary, position, and reason for leaving. Provide your last three jobs, beginning with the most recent employment first.
State the days and hours you are available to work, along with the amount of hours you wish to work each week.
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigations of all statements contained herein and the references and employers listed above to give you one and all information concerning my previous employment and any pertinent information they may have, person or otherwise, and release the company from liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement or the employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.
I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment."