Employment Application Form

Employment Application Form

Employment Application Form

Employment Application Form

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the
application and/or interview process should notify a representative of the Human Resource Department.

Select Location
APPLICANT INFORMATION
Last Name
First Name
MI
Date
Street Address
Apartment/Unit #
City
State
Zip
Phone
Email Address
Date Available
Desired Salary
Position Applied for
Are you authorized to work in the U.S.?
Have you ever worked for this company?
If so, when?
Have you ever plead guilty or no contest to, or been convicted of a crime?
If yes, explain
EDUCATION
High School
Address
Number of years
Did you graduate?
Course of Study
College
Address
Did you graduate?
Course of Study
Other
Address
Did you graduate?
Degree
Skills & Qualifications: Summarize any training, skills, licenses and/or certificates that may qualify you as being able to perform in the position for which you are applying:
PREVIOUS EMPLOYMENT- LIST CURRENT OR MOST RECENT FIRST
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Summarize Job Responsibilities
Employment Duration (From - To)
Reason for Leaving
May we contact your previous supervisor for a reference?
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Summarize Job Responsibilities
Employment Duration (From - To)
Reason for Leaving
May we contact your previous supervisor for a reference?
REFERENCES
Please list three professional references.
Full Name
Relationship
Company
Phone
Address
Full Name
Relationship
Company
Phone
Address
Full Name
Relationship
Company
Phone
Address

DISCLAIMER AND SIGNATURE
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references, employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I herby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 in this regard.

I certify that my answers are true and complete to the best of my knowledge and I have read, fully understand and accept all terms of the foregoing applicant statement.
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Signature
Date
admin none optometrist # # # 8:00 AM - 5:30 PM 9:00 AM - 7:00 PM 8:00 AM - 5:30 PM 8:00 AM - 5:30 PM 8:00 AM - 5:30 PM 8:00 AM - 12:00 PM https://www.facebook.com/LincolnVisionCenter https://www.instagram.com/lincolnvisioncenter/ 4024660165 651 N 66th St. #100 Lincoln, NE 68505 lvc-contacts@eyegrp.com https://goo.gl/maps/Gf7R2sEJJWv8UCfW8 8:00 AM - 5:30 PM 10:00 AM - 7:00 PM 8:00 AM - 5:30 PM 8:00 AM - 5:30 PM Closed 8:00 AM - 12:00 PM https://www.facebook.com/Wahoo-Vision-Center-210871155669897 https://www.instagram.com/wahoovisioncenter/ 4024433168 739 W 10th Street, Suite A Wahoo, NE 68066 wvc-contacts@eyegrp.com https://goo.gl/maps/eFrnwFXPMUUfRbCG6