EMPLOYMENT FORM

Employment Form

Personal Information


 
Application Date*
 
Name*
First
 
Last
 
Date*
Address*
Street Address
Address Line 2
City
State / Province / Region
Home Phone*
Cell Phone*
Email*
Have You Ever Applied For Employment With Us Before?*


If Yes, When?
Are You Over 18 Years Of Age?*


Are You Legally Eligible For Employment In The United States?*


Personal Information

Position Title*
Type*


Desired Salary*
How Did You Hear About Us?*

Work Eligibility/Availability

When Will You Be Able To Begin Working?*
When Will You Be Able To Begin Working?*


Days Available*
Total Hours Available*

Professional Licensure/Certifications

Type/Number
State Issued
Expiration Date
Computer Skills



Experience/Other Qualifications
Did You Graduate?



Other Special Training

Employee History:

Current/Previous Position

 
Company Name
Company Address
Street Address
Address Line 2
City
State / Province / Region
Company Phone
Job Title
Start Date
End Date
May We Contact This Employer?



If No, Why?
Reason For Leave

Past Employer

 
Company Name
Company Address
Street Address
Address Line 2
City
State / Province / Region
Company Phone
Job Title
Start Date
End Date
May We Contact This Employer?



If No, Why?
Reason For Leave

Past Employer

 
Company Name
Company Address
Street Address
Address Line 2
City
State / Province / Region
Company Phone
Job Title
Start Date
End Date
May We Contact This Employer?



If No, Why?
Reason For Leave
Have you been convicted of, pleaded guilty to, or pleaded no contest to an act of dishonesty, or breach of trust or moral turpitude, such as a misdemeanor petty theft, burglary, fraud, writing bad checks and or the use of illegal drugs or related crimes?
Untitled*


If Yes, Please Explain:
Hiring Policy Thank You for your interest in employment with Body Structure Clinic. Please complete the application in its entirety before submitting it to Human Resources. We prefer all applicants to attach, fax, or send a cover letter and a resume with application. If your qualifications meet our needs, your initial phone interview will be with our Human Resources Department. If a position is not available at the time you apply, you will receive notification from us and your application will be kept on file. Body Structure Clinic is an equal opportunity employer and selects employees without regard to race, color, national origin, sex, religion, age, disability, or sexual orientation. Decisions for employment are based on the individuals’ qualifications for the position available.
Agreement of the Transfer of Information & Certification I certify that the information provided by me in this application is true and complete to the best of my knowledge. I understand that if employed, any falsification, misstatement, or omission of fact in connection with application, whether on this document or not, may result in immediate termination of employment. I authorize you to verify any and all information provided on the application and the information that is provided on my resume. I acknowledge that employment may be conditional upon successful completion of a substance abuse screening test as part of the Company’s pre-employment policy. Initial ______
By Initialing Here You Accept All Of Body Structures Above Statements*
0 of 2 max characters
I understand that employment in the Commonwealth of Kentucky is “at will,” which means that either the employee or employer may terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no person, supervisor, manager, or executive is authorized to alter any of the foregoing or to enter into any written or verbal employment contracts without the express written consent of the president. Initial ______
By Initialing Here You Accept All Of Body Structures Above Statements*
0 of 2 max characters
By Typing Your Name Here You Fully Understand All Of Body Structures Above Statements*
 
First
 
Last
 
Sign Date*