Employment Application

Step 1 of 8 - Basic Information

Basic Information

Today's Date:(Required)

Applicant Name:(Required)

First Last

Current Address:(Required)

Street Address City State ZIP Code

Phone 1:(Required)

Phone 2 (optional):

E-mail Address:(Required)

References

List below persons not related to you who have knowledge of your work performance within the last three (3) years.

Reference 1

Name:(Required)

First Last

Phone:(Required)

Email:(Required)

Address:

Street Address City State ZIP Code

Occupation:(Required)

# of Years Acquainted:(Required)

Reference 2

Name:

First Last

Phone:

Email:

Address:

Street Address City State ZIP Code

Occupation:

# of Years Acquainted:

Please Read Carefully - Check and Initial All

Check and Initial(Required)

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. MHS is a drug free environment. All potential employees will be drug/alcohol tested prior to employment offer.

Initials:(Required)

Check and Initial(Required)

I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorized the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

Initials:(Required)

Check and Initial(Required)

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company’s designated representative.

Initials:(Required)

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