Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. – Step 1 of 4 PRECISION MEDICAL, INC. APPLICATION FOR EMPLOYMENT Precision Medical, Inc. is an equal opportunity employer. Precision Medical, Inc. does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service or any other characteristic protected by law. PERSONAL INFORMATION Incomplete information could disqualify you from further consideration. Please complete all fields. Should you need assistance completing this application, please call 610-440-2736. NameDateHome PhoneEmailMobile PhoneAddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAre you eligible to work in the U.S.?YesNoAre you at least 18 years or older? (If no, you may be required to provide authorization to work.) YesNoHave you ever been terminated from employment or asked to resign by an employer?YesNoIf yes, please provide company names and details.Can you work any shift?YesNoIf no, explain:Can you work overtime, including weekends? YesNoAre you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?YesNoNextEMPLOYMENT DESIRED Date you can startHourly rate/Salary desiredPosition desiredAre you currently employed?YesNoIf so, may we inquire of your present employer?YesNoREFERRAL SOURCE How did you hear about us?Walk InAdvertisementReferralOtherOtherPlease specify how you heard about this position.Have you ever worked for this company before?YesNoExplainDo you know anyone who works for our company? YesNoWho?EDUCATION High School Name and location of schoolDegree ReceivedSubjects studied/Major College or University Name and location of schoolDegree ReceivedSubjects studied/Major Trade, Business or Correspondence School Name and location of schoolDegree ReceivedSubjects studied/MajorPreviousNextEMPLOYMENT HISTORY Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration. works in Acquainted Employment History FromToJob TitleEmployer NameImmediate Supervisor and TitleEmployer PhoneEmployer AddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSummarize the nature or work performed and job responsibilitiesReason for leaving Add Remove PreviousNextREFERENCES Give the names of three persons not related to you, whom you have known at least three (3) years. Reference #1 NameAddress, Phone, Email CompanyYears AcquaintedReference #2 Name Address, Phone, EmailCompany Years AcquaintedReference #3 NameAddress, Phone, EmailCompany Years Acquainted PLEASE READ CAREFULLY BEFORE SIGNING. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Precision Medical, Inc. to hire me. If I am hired, I understand that either Precision Medical, Inc. or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Precision Medical, Inc., other than its President or his designee, has any authority to enter into any agreement for employment for any specified period of time or make any agreement contrary to the foregoing either now, or in the future. I further understand that such an agreement must be in writing and signed by the President. I further understand that this statement supersedes any prior oral or written understanding. By signing this application, I declare that the information provided by me is complete and true to the best of my knowledge. I understand that any misrepresentation or omission on this application (or any other accompanying or required documents) may preclude an offer of employment or may result in a withdrawal of an employment offer or may result in my discharge from employment if I am already employed a the time the misrepresentation or omission is discovered. I acknowledge that I have read and understand the above statements. DateSignatureBy typing my name above, I agree that this form of electronic signature has the same legal force and effect as my handwritten signature.THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE ABOVE. Resume Click or drag a file to this area to upload. If applicable, please upload a copy of your resume. Accepted formats: .pdf, .docPreviousSubmit
