Who should be contacted if you are involved in an emergency?
THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.
Ability or Skill Years of Experience Rating
List your current or most recent employment first.
Applicant Employment History
Applicant's Education and Training
List any two people (not related to you) who would be willing to provide a reference for you.
I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if
employment commences immediate termination. I authorize Dominion Staffing to contact former
employers and educational organizations regarding my employment and education. I authorize my former
employers and educational organizations to fully and freely communicate information regarding my
previous employment, attendance, and grades. I authorize those persons designated as references to fully
and freely communicate information regarding my previous employment and education. If an
employment relationship is created, I understand that unless I am offered a specific written contract of
employment signed on behalf of the organization by its Director, the employment relationship will be "atwill." In other words, the relationship will be entirely voluntary in nature, and either I or my employer
will be able to terminate the employment relationship at any time and without cause. With appropriate
notice, I will have the full and complete discretion to end the employment relationship when I choose and
for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative,
or employee of Dominion Staffing, except in a specific written contract of employment signed on behalf
of the organization by its Director, has the power to alter or vary the voluntary nature of the employment
I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.
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