Employment Application

Applicant Information
The following information is requested to help us make the best possible placement within the foundation. All required portions of this application pertaining to you must be completed. We appreciate the time you spend in filling out this application form. The company, in accordance with local, State and Federal laws, does not discriminate based on age, race, religion, color, sex, national origin, marital status, sexual orientation, disability, status about public assistance, or any other protected classification.
Name: *
Name:
Phone: *
Phone:
Current Address: *
Current Address:
Previous Address:
Previous Address:
What positions are you applying for? *
Check all that apply
What species do you prefer to work with? *
Work Days Available: *
Check all that apply
Work Schedule Availability: *
Check all that apply
Are you looking for a full time or part time position? *
Check all that apply
Have you ever worked at The Babinski Foundation before? *
Are you a citizen of the United States? *
Are you legally entitled to work in the United States? *
Have you been convicted of a felony? *
We will be conducting formal background checks.
Emergency Contact Information
This section is for you to put down all of your medical emergency contact information, if you wish to do so. This information will not be used for any other purpose.
Doctor's Name:
Doctor's Name:
Doctor's Phone Number:
Doctor's Phone Number:
Emergency Contact:
Emergency Contact:
Emergency Contact's Number:
Emergency Contact's Number:
Education History
High School Address:
High School Address:
Did you graduate from this high school?
College Address:
College Address:
Did you graduate from this college?
Please list the name of the facility
Other Education's Address:
Other Education's Address:
Did you graduate?
Employment History
Feel free to put down volunteer work as well. I certify that the information contained in this application is correct to the best of my knowledge, and understand that falsification of this application in any detail is grounds for disqualification from further consideration or for dismissal from employment in accordance with company policy. I agree to conform to the company guidelines and rules of the company, and understand that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the company or myself. I further understand that no personnel recruiter or interviewer, other than the owner or the company or authorized agent has any authority to enter into any agreement for employment for any specified period of time.
1. May we contact?
1. Employer Phone Number:
1. Employer Phone Number:
1. Employer Address:
1. Employer Address:
1. Date Started:
1. Date Started:
1. Date Ended:
1. Date Ended:
2. May we contact?
2. Employer Phone Number:
2. Employer Phone Number:
2. Employer Address:
2. Employer Address:
2. Date Started:
2. Date Started:
2. Date Ended:
2. Date Ended:
3. May we contact?
3. Employer Phone Number:
3. Employer Phone Number:
3. Employer Address:
3. Employer Address:
3. Date Started:
3. Date Started:
3. Date Ended:
3. Date Ended:
References
Please list two non-related references .
First Reference: *
First Reference:
First Reference's Phone Number: *
First Reference's Phone Number:
Second Reference: *
Second Reference:
Second Reference's Phone Number: *
Second Reference's Phone Number:
Additional Information
Include their name, species, and age.
Do you have your own transportation?
Do you have an insured truck or van?
Disclaimer
I certify that my answers are true and complete to the best of my knowledge. I certify that my answers are true and complete to the best of my knowledge. If this application leads to me becoming an employee, I understand that false or misleading information in my application may result in my release from the Babinski Foundation. I understand that the Babinski Foundation will be conducting a formal background check. I agree to hold all information shared with me while working at the Babinski Foundation in strict confidence. I authorize any person, agency or institution to release information concerning me. This information will be used to determine my eligibility for employment.
Confidentiality Agreement
This confidentiality agreement is required for the protection of the Babinski Foundation and in recognition that employees/volunteers/board members of the Babinski foundation may either acquire or observe documents, or overhear conversations, or information that is private and confidential in nature. Accordingly, the undersigned employee/volunteer/board member agrees that if he or she comes into possession of either written or oral information of any kind about the Babinski Foundation about its employees/volunteers/board members, or clients as the result of employment/volunteer/board work with the Babinski Foundation, the undersigned agrees to keep all such information confidential and not disclose or publish this information to any person unless expressly permitted in writing by the Babinski Foundation executive director. It is acknowledged that this agreement is not only for the protection of the Babinski Foundation and its clients regarding their confidential information but the agreement is also a reminder to the undersigned that inappropriate disclosure of such information by the undersigned could expose the undersigned to liability or claims if the disclosure of such information cause either monetary damage or other irreparable harm to the Babinski Foundation or its clients.
By entering my full name here, I fully agree to the above written disclaimer and Confidentiality Agreement.