24 Hour Emergency Service
Office Job Application

Office Job Application


Application for Employment

Prospective employees will receive consideration without discrimination based on race, creed, color, sex, age, national origin, handicap, veteran status or any condition prescribed by state or local law.



Graduate School
Business Trade Technical
High School


Please give accurate, complete full-time and part-time employment record. Start with your present or most recent employer.
Employer 1
Employer 2
Employer 3
Employer 4
We may contact the employers listed above unless you indicate those you do not want us to contact.
Do Not Contact:


Additional Information

Applicant Signature

Please read and understand this statement before signing your application.
The information I have provided in this Application for Employment is true, correct and complete. False, incomplete or misrepresented information of any kind, will be sufficient cause for my application to be rejected or, if discovered after I am employed, cause for immediate termination of my employment.
I authorize the employer to contact and obtain information about me from previous employers, educational institutions and references I provided, and any other party necessary to verify the accuracy of information I disclosed in this application, a related employment resume or a personal interview. To assist in the processing of my Application, I waive all rights and claims I may otherwise have against the employer or its representatives, for seeking and using information to evaluate my employment request and all other persons, corporations or organizations who provide information for this purpose.
This Application will expire in 30 days. After that date, unless otherwise notified, I understand that my status as an applicant will end. I may re-apply for employment in the future by completing a new application.
This Application is not an employment agreement. If I accept an offer of employment I understand the employer may terminate my employment at any time, with or without cause and without prior notice, unless required by law. I understand that no one, other than an executive officer of the employer, has authority to enter into any employment agreement with terms contrary to the foregoing and then only in writing signed by such officer.
I fully understand and accept all terms and condition in the above statement.