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Employment Application Form

Your Personal Information

Your Name(Required)
MM slash DD slash YYYY
Your Home Address(Required)
When is the best time for us to reach you via telephone?
Are you over the age of 18?(Required)
Are you currently eligible to work in the U.S.?(Required)
Can you provide documentation that you are eligible to work in the U.S.?(Required)

Employment Information

MM slash DD slash YYYY
Desired Shift(Required)
Desired type of employment(Required)
Hours You Are Available for Work(Required)
Please tell us what hours you are available for work each day of the week. Please include start time and end time.
Monday
Tuesday
Wednesday
Thursday
 
(Required)
Friday
Saturday
Sunday
 

General Questions

Can you perform the essential job functions for which you are applying, with our without reasonable accommodation?(Required)
Have you ever held a position of trust (handling money or confidential material)?(Required)
Do you have reliable transportation to work?(Required)
Have you ever been discharged or asked to resign?(Required)
Do you have any friends or relatives that currently work here?(Required)
Have you ever been bonded?(Required)
Have you ever been refused bond?(Required)
Does your present employer know of your plans to change employment?(Required)
What is your highest level of education completed?
List any applicable licenses

Previous Employment

Your Previous Employers(Required)
Please list your previous employers, the dates you worked and the position you held
Employer
Dates
Position
Phone
 
(Required)
Business Number
Starting Rate $
Ending Rate $
 
MM slash DD slash YYYY
(Required)
Employer
Dates
Position
Phone
 
(Required)
Business Number
Starting Rate $
Ending Rate $
 
MM slash DD slash YYYY
(Required)
Employer
Dates
Position
Phone
 
(Required)
Business Number
Starting Rate $
Ending Rate $
 
MM slash DD slash YYYY
May we contact the employers listed above?(Required)

More About You

The Legal Stuff

Terms and Conditions

The facts set forth above in my application for employment are true and complete. I understand that if employed, false statements or omission of information on this application, a resume, or other applicant information provided may be considered sufficient reason for dismissal. I understand that consumer reports which may contain public record information may be requested from the reporting agency. These reports may include information as to my character, work habits, performance, and experiences along with the reasons for termination of past employment from previous employers. Further, I understand that you may be requesting information from various federal, state, and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil, and other experiences. I understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigative consumer report.

I authorize the use of any information in this application to verify my statements, and I authorized the past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information.

I understand that employment at this organization is on an “at will” basis, and includes no guarantee, contract, or promise of employment for any specific length of time.

Acceptance(Required)
Entering your initials here is to be considered an electronic signature
This field is for validation purposes and should be left unchanged.

©2019-Present Lowcountry Medical Linens - 20 South Main St, Brunson, SC 29911 - 803-632-2558