Job Application

Preliminary Job Application: Printable Application For Employment

Date:	Position(s) desired:		Availability:
			Full Time Part Time Full or Part Time
If you are applying for Part Time, what days and hours are you available?
Full Name:	Current Address:	City:	State:	Zip:	Phone:
How did you learn about us? Advertisement Friend Walk-in Employment Agency Relative

References: List the Name, Address and Telephone Number of three (3) references who are not relatives or former employers.
Name: Name: Name:	Address: Address: Address:	Phone #: Phone #: Phone #:
Please list the extent of your education, including trade schools, apprenticeship programs and military experience:
Briefly explain why you want to work for our company, and what your goals are for the future:

Please answer the following questions with as much detail as necessary:

1. Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
No Yes

2. Have you been convicted of a felony, or are there any convictions pending?
No Yes (If YES give details)

3. Are You Currently Employed? No Yes

4. If you are currently employed, may we contact your employer for references? No Yes

5. On what date are you available to start work?

6. Do you have objections to working Saturdays &/or Sundays if necessary? No Yes

Employment History - List the last three employers you had:
From:				Reason For Leaving:
To:
From:				Reason For Leaving:
To:
From:				Reason For Leaving:
To:

I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that if employed, false statements shall be grounds for dismissal. I authorize investigation of all statements contained and the references listed above 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 from all liability for any damage that may result from furnishing same to you. I understand and agree that if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice. I also understand that the submission of this form is the same as if I signed my signature to a legal document.

Note: After hitting the "SUBMIT" button, you will be taken to a confirmation page. If you are not, your order or inquiry has not been sent. Please e-mail webmaster@inetonline.com to notify us of the problem.
Thank You!!!

If this is an EMERGENCY, PLEASE CALL US at: 262-369-8633 ! ! ! ! ! !

Bailey Family Dental
557 Cottonwood Avenue
Hartland, WI 53029
262-369-8633