医疗管理协会. -医疗保健咨询标志

乔治亚州亚特兰大坎伯兰大道3330号200号套房,邮编30339
Phone: • Fax:

医疗管理协会. -医疗保健咨询标志

Job Application Form

Application for Employment: 雇佣前问卷,以及雇主的平等机会

Personal Information
Date:
Last Name:
First Name:
Middle Initial:
E-Mail Address:
Social Security Number:
Present Address:
Apartment Number:
City:
State:
ZIP:
Permanent Address:
Apartment Number:
City:
State:
Zip Code:
Are you 18 years or older? Yes
No
Home Phone:
Cell Phone:
Are you either a U.S. 公民或被授权在美国工作的外国人? Yes
No
Background Information
被判重罪或轻罪的? ** Yes
No
因工作表现不佳而被试用或解雇? Yes
No
因违反安全规定而受处分或被开除? Yes
No
因旷工而受到纪律处分或被解雇, tardiness, 因故缺席或其他原因未能通知公司? Yes
No
因打架、攻击或类似罪行而受到纪律处分或被开除? Yes
No
因受酒精或毒品影响而受到纪律处分或被开除, or for possession, 酗酒或滥用药物? Yes
No
如果你对上述任何一个问题的回答是肯定的,请描述:
我明白我可能会被要求提供就业资料, references, 信用和背景调查.

**你不会仅仅因为有定罪记录而被拒绝雇佣, 除非你犯的罪与你申请的工作有关.

Employment Desired
Position:
Date you can start:
Salary Desired:
Are you employed now? Yes
No
如果是这样,365体育备用网站可以询问你现在的雇主吗? Yes
No
我以前申请过这家公司? Yes
No
Where?
When?
Education
High School  
学校名称及所在地:
Number of Years Attended:
Did you Graduate? Yes
No
Subjects Studied:

College  
学校名称及所在地:
Number of Years Attended:
Did you Graduate? Yes
No
Subjects Studied:

贸易,商业或函授学校  
学校名称及所在地:
Number of Years Attended:
Did you Graduate? Yes
No
Subjects Studied:
General
特殊学习或研究工作科目:
现任国民警卫队或预备役:
Former Employers

下面列出你最近的三个雇主,从最近的一个开始.

From (month/year):
To (month/year):
雇主名称和地址:
Position:
Salary:
Reason for Leaving:

From (month/year):
To (month/year):
雇主名称和地址:
Position:
Salary:
Reason for Leaving:

From (month/year):
To (month/year):
雇主名称和地址:
Position:
Salary:
Reason for Leaving:
References

下面是三个与工作相关的推荐人的名字. 只提供你准备与MMA联系的参考资料.

目前雇主的推荐信可在稍后提供. 请只提供直接电话号码或分机号码.

Name:
Address:
Phone Number:
Name of Business:
Years Known:

Name:
Address:
Phone Number:
Name of Business:
Years Known:

Name:
Address:
Phone Number:
Name of Business:
Years Known:
Physical Record

你是否有任何身体上的限制,使你不能从事任何你正在考虑的工作?

Yes
No

如果是,你可以做些什么来适应你的限制?
Please describe:

In Case of Emergency:

Name:  
Address:  
Phone Number:  

“我保证本申请所包含的事实是真实和完整的,就我所知并理解, 如在此申请表上作虚假陈述,将被视为解雇的理由.

我授权调查这里所包含的所有声明和上面列出的参考资料给你任何和所有 关于我以前工作的信息以及他们可能知道的任何相关信息, personal or otherwise, and 免除所有方的所有责任,任何损害可能导致提供给你.

I understand and agree that, if hired, 我的雇佣是在随意的基础上,没有明确的期限和可能, 无论我的工资和薪金的支付日期, 一经终止,恕不另行通知."

Date:
Signature:

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