Application for Employment

Application must be completed in full and to the best of your abilities. All applications will be considered.
Personal Information
     
Name: Home Telephone:
Street Address: Other Telephone:
City/State/Zip: Social Security #:
   
Position Desired: Salary Expected:
Full/Part Time? Able to work Overtime?
    Able to work Evenings?
Have you ever worked for us before? Able to work Saturdays?
If so, when? (Month and Year) Date you can start?
   
Are you legally eligible for employment in the United States?    
Other special training or skills (languages, computer training, etc).    
   
Education
           
SCHOOL NAME/LOCATION COURSE OF STUDY YEARS COMPLETED GRADUATE? DEGREE
Graduate
College
Business/ Trade/ Technical
High School
Elementary
           
 

Employment  (list most recent employer first)
       
Company Name: Telephone
Address: Start/End Date: From:      To:  
Supervisor: Salary/Wage:
Job Title/ Description Reason for Leaving:
       
Company Name: Telephone
Address: Start/End Date: From:      To:  
Supervisor: Salary/Wage:
Job Title/ Description Reason for Leaving:
Company Name: Telephone
Address: Start/End Date: From:      To:  
Supervisor: Salary/Wage:
Job Title/ Description Reason for Leaving:
       

Our company verifies all application information. Are there any employers listed above that you do not wish us to contact?

Specify Employer name and reason(s) here:
     

Whom may we thank for referring you?  

How did you hear about this position?   

Any special skills or qualifications that you would like us consider?

By signing below with my electronic signature, I attest that the information contained within this electronic employment application is true, accurate, and complete to the best of my knowledge. I understand that, if employed, any misstatement, misrepresentation, or omission of fact in this application could result in my immediate dismissal. I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future. I understand that Weaver Eye Associates may, at their discretion, engage an investigative consumer reporting agency to report on my credit and personal history, and I authorize them to do so.

Email Address:

Please select whether or not you agree with the above terms (required):       

Entering your name here constitutes your electronic signature: 

Today's Date: 

        

 

Prospective employees will receive consideration without discriminations because of race, creed, color, sex, age, sexual orientation, national origin, handicap or veteran status.

© 2010 Weaver Eye Associates - All Rights Reserved