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Employment Application

Personal Information

000-000-0000 or (000) 000-0000

Position Applying For (Required)

Select an option

General Information

Please list your areas of highest proficiency, special skills or other items that may contribute to your abilities in performing the above mentioned position.

Education

Most Recent Employers

Employer 1

Start Date

End Date

Employer 2

Start Date

End Date

Employer 3

Start Date

End Date

References

Not related to you, whom you have known for at least two years

Reference 1

Reference 2

Reference 3

Availability

Please mark off shifts you are NOT able to work

Day shift 10:00 am - 6:00 pm
Night shift 5:00 pm - 2:00 am (latest)

Do you need any time off? (Required)

Select an option

Authorization

By signing below, you acknowledge the following: The above information, to the best of my knowledge, is true. I understand that any misrepresentation or willful omission of facts on my application for employment, regardless of when discovered, is cause for my immediate discharge. I further acknowledge that this application form must be completed fully in order for me to be considered for employment at de Lazy Lizard. I authorize de Lazy Lizard to investigate my personal background, qualifications, and references. I understand that my employment is conditioned upon responses to reference checks which are satisfactory. I hereby release from any liability all representatives of de Lazy Lizard for acts performed in good faith and without malice in connection with investigating and evaluating my application, including contacting any references available to de Lazy Lizard. I further release from any liability all individuals and organizations who provide information to de Lazy Lizard in good faith and without malice concerning my qualifications. Under Maryland law, an employer may not require or demand, as a condition of employment, prospective employment, or continued employment, that an individual submit to or take a polygraph examination or similar test. An employer who violates this law is guilty of a misdemeanor and subject to a fine not exceeding $100.

Date (Required)

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