Professional Regulation and Criminal Liability Paper

1355 Words6 Pages
Pioneer Health Services, Inc. APPLICATION FOR EMPLOYMENT An Equal Opportunity Employer Referral Source:_________________ We do not discriminate on the basis of race, color, religion, national origin, sex, age, or disability. It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job related factors. Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. Use blank paper if you do not have enough room on this application. PLEASE PRINT, except for signature on the back of this application. In reading and answering the following questions are aware that none of the questions are intended to imply illegal…show more content…
___________________________________________________________ __________________________________________________________________________________________________________________________________ What machines or equipment can you operate that relates to the job for which you are applying: ______________________________________________________ __________________________________________________________________________________________________________________________________ List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. Note: A job offer may be contingent upon acceptable references from current and former employers. ___________________________________________________________________________________________________________________________________ (Name of Employer) (Address, City, State and Zip Code) (Phone Number) (Supervisor) Dates of employment: From: _____/_____/_____ To: _____/_____/_____ Starting Pay Rate: ___________________ Final Pay Rate: ______________________ Reason for Leaving:
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