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Job Application

Personal Information

First Name*
Middle Name
Last Name*
Street Address*
City*
State*
Zip*
Telephone*
Email*

Employment Desired

Part-time Applicants, Please Describe Availability*
Position Desired*
Date Available*
Salary Desired*
What Shift(S) Will You Work?*
Seeking Full Or Part Time Work?*
Number Of Hours*
Are You Employed?*
If Yes, May We Contact Your Present Employer?*
If We May Not Contact Your Employer, Please Explain*

Education/Military Service

High School
Year Attended
Did You Graduate?
Subjects Studied Or Degree
College
Year Attended
Did You Graduate?
Subjects Studied Or Degree
Trade School
Year Attended
Did You Graduate?
Subjects Studied Or Degree
Military Service
Rank
Honorably Discharged?
Specialized Training Or Certificates.
Are You Capable Of Performing The Essential Functions Of This Position?
Are You Legally Authorized To Work In The United States?
Have You Ever Been Convicted Of A Felony? If You Have, Please Explain:

Former Employers

Former Employer #

Name
From
To
Starting Salary
Ending Salary
Phone
City/State
Supervisor Name & Title
Position
Job Duties
Reason For Leaving

Professional References

Name
Company
Phone

I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be grounds for immediate dismissal. I authorize investigation of all statements contained herein and the references/employers listed to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties form all liability for any damage that may result from utilization of such information. I acknowledge that, if I become employed, I will be free to terminate my employment at any time for any reason and Tess Oral Health retains the same rights. No Tess Oral Health representative has the authority to make any contrary agreement. This application does not establish an employment contract.

Signature*
Date*
Attach cover letter (doc, pdf)*
Choose file
Attach resume (doc, pdf)*
Choose file

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