I, , certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me or for discharge should I be hired.
I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment.
I also authorize you to request and receive such information. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added or interpreted at any time, at the company’s sole option and without prior notice to me.
I also acknowledge that my employment may be terminated, or any offer or acceptance of employment withdrawn, at any time, with or without cause, and with or without prior notice at the option of the company or myself.
I understand that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to assure or make some other personnel move, either prior to commencement of employment or after I have become employed, or to assure any benefits or terms and conditions of employment, or to make any agreement, that is contrary to the foregoing.
Last Name: | First Name: | M.I.: | Date of Birth:
Phone Number: | Social Security Number:
Company: | Location:
Pay Rate: $ | Full or Part-time: | Pay Form:
Employee #: | Client: | Recruited From:
Form of ID, List A: | Exp. Date:
Form of ID, List B: | Exp. Date:
Form of ID, List C: | Exp. Date:
BG: | SSV: | Reason: | S/M:
DEP: | Dep Others: | EEY/IC:
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: Acknowledgment
Agree & Sign