Employment Application (1) An Equal Opportunity EmployerPosition applying for:*REGISTERED NURSERECEPTIONISTDate of Application:* Date Format: MM slash DD slash YYYY Last Name*First Name*MI*Date of Birth(Optional): Date Format: MM slash DD slash YYYY Street Address*City*State*Zip*E-mail Address* Phone*Are you authorized to work in the United States?*YesNoAre you at least 18 years old? ( If under 18, hire is subject to verification that you are of minimum legal age)*YesNoIf hired, would you have a reliable means of transportation to and from work?*YesNoEducationName of High School*High School Graduated*High School, Number Of Years*High School, Major/Degree*Name of College*College Graduated*College, Number Of Years*College, Major/Degree*Name of Other*Other GraduatedOther, Number Of YearsOther, Major/DegreeDo you have any friends or relatives working for our Company?*YesNoIf yes, state name(s) and relationship:Do you speak any languages other than English?*YesNoIf yes, please list :If you are applying for a position that requires a license, are you licensed for the position?*YesNoLicense Number (if applicable):Has your license/certification ever been suspended or revoked?*YesNoEmployment / Work ExperienceList below all present and past employment starting with your most recent employer.Company:*Address*Phone*EmployedFrom Date* Date Format: MM slash DD slash YYYY To Date* Date Format: MM slash DD slash YYYY Supervisor:*Job Title:*Responsibilities:*Reason for Leaving*May we contact this employer?*YesNoCompany:AddressPhoneEmployedFrom Date Date Format: MM slash DD slash YYYY To Date Date Format: MM slash DD slash YYYY Supervisor:Job Title:Responsibilities:Reason for LeavingMay we contact this employer?YesNoCompany:AddressPhoneEmployedFrom Date Date Format: MM slash DD slash YYYY To Date Date Format: MM slash DD slash YYYY Supervisor:Job Title:Responsibilities:Reason for LeavingMay we contact this employer?YesNoIdentify and explain all periods of unemployment during the past seven years.Attach your resume*Please Read Carefully, Initial Each Paragraph and Sign BelowInitials*I certify under penalty of perjury that my answers are true and complete to the best of my knowledge. I have not knowingly withheld any information that might adversely affect my chances for employment. I further certify that I have personally completed this application. I understand that any omission or misstatement of fact on this application or on any document used to obtain employment will be grounds for rejection of this application or for immediate termination if I am employed, no matter when discovered.Initials*I authorize the Company to thoroughly investigate my work record, education, and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me notice of such disclosure. In addition, I release the Company, my former employers and all other persons, corporations, partnerships and associations from liability arising out of or in any way related to such investigation or disclosure.Initials*I understand that nothing contained in the application, or conveyed during any interview that may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, unless indicated in the employment agreement and in writing, my employment is “at will”, for no definite time period and may be terminated at any time, with or without notice, at the option of either myself or the Company. Unless a written agreement exists, the employment is “at will”. Disclaimer and SignatureI,, hereby authorize New Look Skin Center to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. I understand that New Look Skin Center may utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company's choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for employment will not be processed further.Applicant Name Printed:*Signature of Applicant:*Date* Date Format: MM slash DD slash YYYY