Employment Application for Employment Please enable JavaScript in your browser to complete this form.Name *FirstMiddleLastAddress *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate *Telephone# *DOB *Other Name/s I have been known by *(For the sole purpose of running a MN Background check, a requirement to be considered for employment with MABS Recovery Center)Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.) *YesNoAre you looking for full-time employment? *YesNoIf no, what hours are you available? *Are you willing to work swing shift? *YesNoAre you willing to work graveyard? *YesNoHave you ever been convicted of a felony? (This will not necessarily affect your application.) *YesNoIf yes, please describe conditions. *Employment DesiredPosition applied forHow did you hear of this opening?Have you ever applied for employment here? *YesNoWhen?Where?Have you ever been employed by this company? *YesNoWhen? Where?Are you presently employed? *YesNoMay we contact your present employer? *YesNoAre you available for full-time work? *YesNoAre you available for part-time work? *YesNoWill you relocate? *YesNoAre you willing to travel? *YesNoIf yes, what percent?Date you can startDesired positionDesired starting salarySchool Name and LocationSchool Type *High SchoolCollegePost-CollegeOther TrainingSchool NameYear MajorDegreeIn addition to your work history, are there are other skills, qualifications, or experience that we should consider?Please list any scholastic honors received and offices held in school.Are you planning to continue your studies?YesNoIf yes, where and what courses of study?Employment History (Most Recent)CompanyTelephoneAddressDate StartedStarting WageStarting PositionDate EndedEnding WageEnding PositionSupervisorMay we contact?YesNoResponsibilitiesReason for leavingReason for leavingReferencesPlease provide three references, not related to you, who have known you at least one year.Name *PhoneYears KnowAddressEmergency ContactsName *PhoneAddressRelationshipPlease Read Before SigningI certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application. I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees. I further Authorize MABS Recovery Center to submit/run a MN Department of Human Services Criminal Background Check on myself utilizing my social security number as well as my driver’s license (if applicable). All finding will be kept confidential. In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. I have received from the company a list of the approved documents that are required. I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I hereby acknowledge that I have read and understand and agree to the above statements.SignatureDateSubmit
