Premium Choice Care
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Are you 18 years of age or older?
Date available to work
Are you employed?
If you are employed,May we contact your current employer?
Have you ever applied for this company before?
Are you authorized to work in the US?
How did you hear about us?
If you are refered by curent employee,please write the employee full name below
Please write three references full Name/Relationship and tittle,Company detail and contact number
Please list any other job-related information you think would be helpful to us in considering you for the position, such as any additional work experience, volunteer activities, hobbies, social activities, clubs or professional organizations (list offices held), publications, accomplishments, etc. (Exclude information indicative of race, color, religion, sex, age, marital status, national origin, disability, or veteran status.)
When and where did you graduate from high school?
Maximum level of educationachived
Some College Certificate
Some College Course
High School Diploma
Write name of college attended ,graduation year and Major
List any licenses,awards,certifications or registrations pertinent to your application
List the last four employers you have worked for including Name,address,phone number of the employer,position,supervisors name and salary
Acceptance of this application affords no assurance of eventual employment. If employed, you will be required to verify your ability to legally accept employment in the United States. For certain jobs, background investigations, to include contacting former employers, may be required. This application does not constitute a contract of employment. Employment and compensation can be terminated with or without notice, and with or without cause, at any time. I have read the foregoing instructions and question and to the best of my knowledge my answers are true and correct. I have not knowingly misrepresented or withheld any fact or circumstance that would, if disclosed, affect my application unfavorably. I understand that misrepresentation of any of the above may be cause for termination.
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