Name of Employer Name of Supervisor Address City State Zip Phone No. Reason for Leaving Duties Performed: Job Title Start Date End Date Salary Hourly Weekly Monthly Annually Name of Employer Name of Supervisor Address City State Zip Phone No. Reason for Leaving Duties Performed: PERSONAL REFERENCES List three persons other than relatives that we may contact. Name No. Relationship Email Address Name Phone No. Relationship Email Address Name No. Relationship Email Address By submitting this application, I certify that all my statements made by me on this application and/or attached resume are true and correct to the best of my knowledge and that I have withheld nothing which, if disclosed, would affect this application unfavorably. I authorize my previous employers, schools, and references to give any information regarding employment or my educational record. I agree that this agency and my previous employers shall not be held liable in any respect if a job offer is not extended, is withdrawn, or my employment is terminated because of false statements, omissions, or answers made by me on this application. I understand that all job offers may be withdrawn if the result of any background check is not considered satisfactory by IHL. For HR Office Use Only Job # Date Received
Name of Employer Name of Supervisor Address City State Zip Phone No. Reason for Leaving Duties Performed: Job Title Start Date End Date Salary Hourly Weekly Monthly Annually Name of Employer Name of Supervisor Address City State Zip Phone No. Reason for Leaving Duties Performed: PERSONAL REFERENCES List three persons other than relatives that we may contact. Name No. Relationship Email Address Name Phone No. Relationship Email Address Name No. Relationship Email Address By submitting this application, I certify that all my statements made by me on this application and/or attached resume are true and correct to the best of my knowledge and that I have withheld nothing which, if disclosed, would affect this application unfavorably. I authorize my previous employers, schools, and references to give any information regarding employment or my educational record. I agree that this agency and my previous employers shall not be held liable in any respect if a job offer is not extended, is withdrawn, or my employment is terminated because of false statements, omissions, or answers made by me on this application. I understand that all job offers may be withdrawn if the result of any background check is not considered satisfactory by IHL. For HR Office Use Only Job # Date Received
hr-01.docx