Braaten Health

Application For Employment

We are an Equal Opportunity Employer



PERSONAL











Are you 18 years of age or older?:

Do you want to work:



Have you worked for us before?:



Have you ever been convicted of a crime?:


Note: Conviction record will not necessarily be a bar to employment.

EDUCATION and TRAINING

Name and Address of School Choose last year completed Graduated Degree Major

Certificate of Training/Licensure/
Professional Registration
Licensure/Registration
Number & Issuing Agency
Date Issued
Expiration Date




STRENGTHS AND SPECIAL SKILLS



TECHNICAL SKILLS







PROFESSIONAL DESIGNATIONS/ORGANIZATIONS

In this section, exclude any activity or organization which indicates sex, age, disability, race, religion, color, national origin, marital status, affect ional preference or veteran status.






GENERAL

U.S. Military service experience:






If driving is an essential function of the position, list








EMPLOYMENT

List your work history for a minimum of FIVE YEARS. Start with the present and work backwards. Include: 1) all full-time jobs, 2) all part-time jobs, 3) all periods of self-employment, and 4) all periods between jobs. When between jobs, enter UNEMPLOYED in the space for "Employer", show the dates, and explain period between jobs.


Employer:
Address:
Telephone:
Supervisor:
May we contact?: Yes Your Job Title:
Length of Service
From:
To:
Hourly Rate/Salary
Starting:
Final:
Duties and Responsibilities:


Reason for Leaving:


Resume

If you have a resume in MS Word format, please use the field below to upload that for consideration with your resume:



Braaten Health

Please read Carefully before Signing This Form
  1. All information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired.
  2. I authorize the company to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with me or my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information, whether favorable or unfavorable, about me or my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me or my employment.
  3. I understand that upon receiving a job offer, a physical examination and drug screening may be required. (Note: If this is a job requirement, you will be notified.)
  4. Regardless of whether or not I become employed by the company, I recognize that this application is not and should not be considered a contract of employment. I understand that employment at the company is on an at-will basis and that my employment may be terminated with out without cause, and without notice, at any time, at my option or the company´┐Żs, unless specifically provided otherwise in a written employment contract. I further understand that no company employee or representative has the authority to enter into a contract regarding duration or terms and conditions of employment other than an officer or official of the company, and then only by means of a signed, written document.