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(Note: Conviction of a crime will not necessarily preclude your employment)(Required)Record of EducationName of High School(Required)High School Graduation Date(Required) Month Day Year Name of College(s)(Required)College Major(Required)College Graduation Date(Required) Month Day Year College Degree(Required)List Other Education: Include school name, major, graduation date and degree(Required)Employment RecordAre you currently employed?(Required) Yes No Current Employer's Name(Required)Current Employment Start Date(Required) MM slash DD slash YYYY Current Employment Position(Required)Current Employment Starting Pay(Required)Current Employment Ending Pay(Required)Reason for Seeking Other Employment(Required)Previous Employer's Name(Required)Previous Employment Start Date(Required) MM slash DD slash YYYY Previous Employment End Date(Required) MM slash DD slash YYYY Previous Employment Position(Required)Previous Employment Starting Pay(Required)Previous Employment Ending Pay(Required)Reason for Leaving Previous Employer(Required)Do you have other work history?(Required) Yes No Previous Employer's Name (2)(Required)Previous Employment Start Date (2)(Required) MM slash DD slash YYYY Previous Employment End Date (2)(Required) MM slash DD slash YYYY Previous Employment Position (2)(Required)Previous Employment Starting Pay (2)(Required)Previous Employment Ending Pay (2)(Required)Reason for Leaving Previous Employer (2)(Required)Do you have any additional work history?(Required) Yes No Additional Work History: List company name, employment start and end date, start and end pay, and reason for leaving(Required)**Adapt For Life provides equal employment opportunities without regard to race, color, sex, citizenship, national origin, ancestry, or on the basis of age or physical or mental disability. I certify that the information in this application is true and complete for all practical purposes. Should a position be offered and later it is found that any of this information is untrue, incomplete, or misrepresented, I understand and agree that the Adapt For Life has the right to end my employment. I voluntarily give Adapt For Life the right to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release from all liability or responsibility all persons, companies or corporations supplying such information. I understand that my employment is at will and that either party is free to terminate the employment relationship at any time without cause. I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form. If employed, I will be required to complete an Employment Verification Form (I-9) and within 3 days show satisfactory evidence of identity and eligibility for employment.Applicant Signature(Required) Δ
