Employment Application

Fields marked (*) are mandatory
Applicant Information
Name *  
Date*  
Address *  
City*  
State*  
ZIP Code*  
Phone*  
E-mail Address*  
Date Available*  
Social Security No*   # Obtain at the time of Interview
Desired Salary*   $
Position Applied for*  
Are you legally authorized to work in the United States? *   Yes No
Note:  Documents which establish your work
authorization and identity will be required prior to
employment.
Have you ever worked for this company?   Yes No  

Have you ever been convicted of or pled guilty or “no contest” to a crime? Yes No
Education
High School* Address*
From* To*
Did you graduate?* Yes No   Degree*
 
College* Address*
From* To*
Did you graduate?* Yes No   Degree*
 
Other Address
From To
Did you graduate? Yes No   Degree
References (Please list three professional references.)
Full Name* Relationship*
Company* Phone*
Address*
 
Full Name* Relationship*
Company* Phone*
Address*
 
Full Name* Relationship*
Company* Phone*
Address*
Former Employment
Company Phone
Job Title Supervisor
Address
Starting Salary   Ending Salary
Responsibilities
From   To
Reason for Leaving
May we contact your previous supervisor for a reference? Yes No
 
Company Phone
Job Title Supervisor
Address
Starting Salary   Ending Salary
Responsibilities
From   To
Reason for Leaving
May we contact your previous supervisor for a reference? Yes No
 
Company Phone
Job Title Supervisor
Address
Starting Salary   Ending Salary
Responsibilities
From   To
Reason for Leaving
May we contact your previous supervisor for a reference? Yes No
Military Service Yes No
Notice and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may disqualify me for employment consideration and, if I am hired, may be grounds for termination at a later date.

I further acknowledge that should I be given employment, such employment shall be for an indefinite period of time and may be terminated, at will, at anytime, for any reason, by me or by the Company without notice. 

I hereby affirm that by execution of the application, I acknowledge that Resnik Skin Institute has disclosed to me that a Consumer Report and/or Investigative Consumer Report may be obtained.  I hereby authorize and consent to the release of information about my ability, employment history, and fitness for employment by employers, schools, law enforcement agencies, and other individuals and organizations to investigators, personnel staff, and other authorized employees of Resnik Skin Institute for employment purposes.  This consent shall continue to be effective during my employment if I am hired.

Resnik Skin Institute is an Equal Opportunity Employer. We support a smoke-free, drug-free environment.

Signature

*If completing this form in a digital format, by printing my name in the above line, I acknowledge that this is my digital signature and understand it to be as legally binding as a cursive signature.

 
Fair Credit Reporting Act Disclosure and Authorization

This is to notify you that in connection with your application for employment, in addition to conducting an employment background or reference check, we may procure a consumer report on you as part of the process of considering your application. In the event that information from the report is utilized in whole or in part in making an adverse decision, before making the adverse decision, we will provided you with a copy of the consumer report and a description in writing of your rights under the Fair Credit Reporting Act.

Please be advised that we may also obtain an investigative consumer report including information as to your character, general reputation, personal characteristics, employment history, and fitness for employment. This information may be obtained by contacting your present and previous employers or references supplied by you. Please be advised that you have the right to request, in writing, within a reasonable time, that we make a complete and accurate disclosure about the nature and the scope of the information requested.

By signing below, I, , hereby voluntarily authorize Resnik Skin Institute to obtain either a consumer report or an investigative consumer report about me and to consider this information for employment purposes. I understand I have rights under the Fair Credit Reporting Act. This release and authorization shall remain valid and in effect during the term of your employment. We reserve the right to run subsequent consumer reports and/or investigative consumer reports on an as-needed basis.

Signature

*If completing this form in a digital format, by printing my name in the above line, I acknowledge that this is my digital signature and understand it to be as legally binding as a cursive signature.