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Application for Employment

Vacancy Desired

Education

Skills

Are you experienced with:

Work Experience

Please list previous work experience with most recent first.

Employer 1

Employer 2

Employment References

Reference 1

Reference 2

Reference 3

Authorization and Acknowledgements

Please read the following statements carefully and indicate your understanding and acceptance by responding in the affirmative in the space provided.

I certify that all the information in this application is true and correct, and I further understand that any misstatement or omission of information may be grounds for disqualification or immediate dismissal.

I authorize all persons listed on my application to give HOPE Clinic any and all information regarding my previous employment and education and any other pertinent information they may have, personal or otherwise, and release all parties, such persons, and HOPE Clinic from liability for any damage that may result from furnishing same to HOPE Clinic.

I certify that all the information contained in this application (and any accompanying information that I may submit) is true and correct, and further understand that any misstatement or omission of information is grounds for rejection of employment, or if employed, termination from HOPE Clinic. In addition, I authorize HOPE Clinic to obtain copies of any information pertaining to any criminal history maintained by any law enforcement agency and to use said information for the purpose of evaluation of my application for employment. I understand that any falsification of this record will be sufficient cause for disqualification. I understand that this application becomes the property of HOPE Clinic which reserves the right to accept or reject it. I understand that personal or other information obtained from my references becomes a part of this record, is to be regarded as confidential and shall not be revealed to me.

If employed by HOPE Clinic, I understand that I must conform to the rules, regulations and policies of HOPE Clinic.

If I am employed in HOPE Clinic without a contract (at will), I understand that my employment can be terminated, with or without cause or notice, at any time, at the discretion of either HOPE Clinic or myself. I further understand that no representative of HOPE Clinic, other than the Chief Executive Officer (CEO) of HOPE Clinic, has any authority to enter into any agreement, oral or written, for employment for any specified period of time or to make any assurance or promise of continued employment.

This application becomes a public record and is subject to disclosure, except as otherwise noted.

By checking the box below you are providing an electronic signature confirming your understanding of, and agreement with, all terms and conditions stated above.

*Not all applicants will be contacted, only qualified/finalists will be contacted*