Employment Application - Careers at Schmitt Woodland Hills

Date *

Email *

Phone *

Name *

First

Middle

Last

Previous Names Used

To assist in checking your work, school or other records, please indicate if you have been known by any other names

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date Available *

Desired Salary *

Are you over 17 years of age? *

Yes
No

Position Applying For *

Are you seeking *

Full Time
Part Time

Are you able to rotate shifts, if applicable? *

Yes
No

Shift desired? *

Day
Eve
Night
Any

What other positions would you consider? *

Have you ever filed an application with us? *

Yes
No

Registry or Professional License Number:

Registry or Professional License Number State

Are you a citizen of the United States? *

Yes
No

Have you ever worked for this company? *

Yes
No

Do you have any convictions within the last seven years? *

Yes
No

Summarize special skills, qualifications, and certifications acquired from employment or other experience *

Are there any limitations that would prevent you from performing ALL duties of the job for which you are applying? *

Yes
No

High school

Name of High School

High School Address

Attended From

Attended To

Did you graduate?

Yes
No

Degree

College

Name of College

College Address

Attended From

Attended To

Did you graduate?

Yes
No

Degree

Other

Name

Address

Attended From

Attended To

Did you graduate? (copy)

Yes
No

Degree

Current/Last Employer

Company

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor Name

First

Last

Job Title

Ending Salary

Responsibilities

Date Started

Date Left

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes
No

Previous Employer

Company

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor Name

First

Last

Job Title

Ending Salary

Responsibilities

Date Started

Date Left

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes
No

Previous Employer

Company

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor Name

First

Last

Job Title

Ending Salary

Responsibilities

Date Started

Date Left

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes
No

I certify that my answers are true and complete to the best of my knowledge and I have not withheld any fact.

I authorize investigation of all statements contained in this application and further authorize my former employers, government agencies, schools, and personal references to provide any information they have regarding me. I hereby release all employers, government agencies, schools and references from any liability for providing information concerning me.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release and that my employment here is contingent upon a physical exam, background check.

I agree to conform to the rules and regulations of my employer and that my employment and compensation can be terminated with or without cause and with or without notice at any time at the option of either my employer or myself. I understand that no company representative other than the Executive Director has any authority to enter into any agreement for any specified period of time, or make any agreement contrary to the foregoing.

I hereby acknowledge that I have read or had read to me and understand the above statements.

Signature *

First

Last

High school

College

Other

Current/Last Employer

Previous Employer

Previous Employer

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