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Street City State Zip

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Personal References

Employment History

Starting with your present or most recent job, list your employment experience, up to your last three jobs. You may include job-related military service assignments and volunteer activities that reflect your qualifications for employment. Do not omit any employment. Please fill out all information completely. If you have resume, please attach.

1st Employer

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2nd Employer

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3rd Employer

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Applicant's Statement

Please indicate that you have read and understand each paragraph of this Statement by placing your initials beside each paragraph.

  I certify that this application was completed by me and that all entries on it and all information in it are TRUE and COMPLETE to the best of my knowledge. In the event of employment, I understand that false, misleading, or omitted information in my application may result in termination.
  I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In making this application for employment, I understand that the information may be obtained through interviews with the personal references and past employers. This inquiry may include information as to my character, general reputation, and personal characteristics, as well as information about my work performance and workplace conduct. I consent to this review and to the consideration of any statements of reference or former employers that are given in response to the inquiry.
  I hereby release all parties, including Sunny Center, personal references, and previous employers, from liability for any injury or damage that my result from their furnishing information concerning me or any action Sunny Center takes on the basis of such information.
  I understand that, according to federal law, all individuals who are hired must, as a condition of employment, produce certain documentation to verify their identity and United Sates citizen status or, if aliens, their legal authorization to work in the United States. As a consequence, I understand that any offer of employment to me is contingent upon my ability to produce the required documentation within the time period required by law.
  I understand that this application is not, and is not intended to be, a contract of employment and that any resulting employment relationship is for no fixed period of time and is terminable at any time and for any reason by Sunny Center or by me. I further understand that statements which may be contained in policies, practices, handbooks, or other firm material do not create any guarantee of employment and that Sunny Center has the right to modify, amend, or terminate policies, practices, benefit plans, or other programs within the limits and requirements imposed by law.

Sunny Center is an equal opportunity employer. Applicants are considered for employment without regard to race, color, national origin, religion, sex, sexual orientation, disability, citizenship status, or any other basis prohibited by law, unless such basis constitutes a bona fide occupational qualification. Sunny Center will comply with its obligation to provide reasonable accommodation toqualified individuals with disabilities

Applications are kept for 30 days

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