Employment Experience
List name, address and phone number of previous employer(s).
List most recent employer first.
Employment #1 (most recent)
Job title:
Dates of employment:
from: to:
Immediate supervisor:
Salary
Last salary: Hourly, Monthly, or Yearly:
Employer information
Company/employer: Phone: Address: Duties: Reason for leaving:
May we contact this employer?
Yes No If not, please provide your reason:
Employment #2 (most recent)
Job title:
Dates of employment:
from: to:
Immediate supervisor:
Salary
Last salary: Hourly, Monthly, or Yearly:
Employer information
Company/employer: Phone: Address: Duties: Reason for leaving:
May we contact this employer?
Yes No If not, please provide your reason:
Employment #3 (most recent)
Job title:
Dates of employment:
from: to:
Immediate supervisor:
Salary
Last salary: Hourly, Monthly, or Yearly:
Employer information
Company/employer: Phone: Address: Duties: Reason for leaving:
May we contact this employer?
Yes No If not, please provide your reason:
Employment #4 (most recent)
Job title:
Dates of employment:
from: to:
Immediate supervisor:
Salary
Last salary: Hourly, Monthly, or Yearly:
Employer information
Company/employer: Phone: Address: Duties: Reason for leaving:
May we contact this employer?
Yes No If not, please provide your reason:
Employment #5 (most recent)
Job title:
Dates of employment:
from: to:
Immediate supervisor:
Salary
Last salary: Hourly, Monthly, or Yearly:
Employer information
Company/employer: Phone: Address: Duties: Reason for leaving:
May we contact this employer?
Yes No If not, please provide your reason:
May we run a detailed employment check, including, but not limited to, a check with your previous employer(s)?
Yes No
Job Applicant’s Agreement and Certification
Carefully read this section prior to providing signature below
“I certify that the information given by me in this application is true in all respects, and I agree that if the information given is found to be false in any way, it shall be considered sufficient cause for denial of employment or discharge. I authorize the use of any information in this application to verify my statements, and I authorize the past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages as a result of having furnished such information.”
“I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between Loretto and myself for either employment or for the provision of any benefit. No promises regarding employment have been made to me, and I understand that no such promises or guarantee is binding upon Loretto unless made in writing. If an employment relationship is established, I understand that I have the right to terminate any employment at any time and that Loretto retains the same right.”
“I understand that prior to being offered employment with Loretto, I will be requested to take an employment examination. In the event that I have a disability that will affect my ability to take the test, I will so inform Loretto prior to the administration of the test so that a reasonable accommodation can be made. Requested accommodations may include accessible testing sites, modified testing conditions, and accessible testing formats. Loretto reserves the right to require medical documentation concerning the need for the accommodation.”
“I understand that if employed, policies and rules which are issued are not conditions of employment and that the employer may revise policies and procedures, in whole or in part, at any time.”
“I understand that this application will be kept on active file for 6 months from the date completed, after that time, I would have to reapply in accordance with established company procedures.”
I agree to the above terms
