| PERSONAL INFORMATION: |
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| Name: |
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| Name you would like to be called: |
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| Home Phone: |
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| Other Phone: |
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Email Address:
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| In case of emergency notify (Name) |
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| (Address, telephone #) |
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EMPLOYMENT DESIRED |
| Position |
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| If so, please describe your experience |
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GENERAL |
| What are some of the things you would like to achieve in the next year of your profession? |
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| What would you contribute to Visions? |
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| What are your long-term professional goals? |
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Do you have a problem with any of the conditions for employment listed below? |
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| If you answered yes to any questions 1-6, please explain: |
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| If yes, please explain and state court, date and disposition of case |
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EMPLOYMENT HISTORY Please list your last 3 jobs starting with your most recent or present employer. |
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PLEASE READ CAREFULLY
* I hearby certify that the information contained In this application is true and correct to the best of my knowledge and agree to have any statements verified by Visions. I authorize the references listed above, as well as all other individuals whom the company contacts, to provide Visionswith all employment and job-related information they may have. Further, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to the company as well as from the use or disclosure of such information by the company or any of it's agents, employees or representatives. I understand that any misrepresentation, falsification or material omission of information on this application may result in my failure to receive this offer or, if I am hired, dismissal from employment. If hired, I agree to conform to the rules and standards of the company. I further agree that my employment and compensation can be terminated at will, with or without reason, and with or without notice, at any time, either at my option or at the option of the company. I understand that no employee or representative of the company, other than the president, has the authority to enter into any agreement for employment for any specified period of time, or make any express or implied agreement for a specified time unless the president and I both sign a written agreement that clearly and expressly specifies intent to do so. I agree that this shall constitute a final and fully binding integrated agreement with respect to the at-will nature of my employment relationship and that there is no oral or collateral agreements regarding this issue. I also understand that all offers of employment are conditioned on the company's receipt of satisfactory responses to reference requests and the provision of satisfactory proof of applicants identity and legal authority to work in the United States. Offers of employment may also be conditioned on the satisfactory completion of a post-offer medical examination. |
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Visions is an equal opportunity employer. Visions does not discriminate on the basis of race, color, sex, sexual orientation, age, disability that does not prohibit the performance of essential job functions with or without reasonable accommodations, religion, national origin, marital status, status as a veteran or any other status or condition protected by applicable state and/or federal laws.
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