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4171 Oceanside Blvd #109,
Oceanside, CA 92056

Employment Application

Should you need any special accommodations to participate in the application process (i.e. assistance in completing the application, accommodations for the interview, accommodations for any job-related employment tests, or any other needed accommodations), please let us know at the time of application, or at the time an appointment is scheduled

Personal Information






(In accordance with the immigration Reform and Control Act of 1986, any offer of employment is conditioned upon satisfactory proof of applicant’s identity and legal ability to work in the United States.)





(If less than 18 yrs., you will need to provide a work permit and/or age certificate upon offer of employment)


If YES, please explain: (such a conviction will not necessarily disqualify you from employment with Client Name. Please attach an additional sheet if necessary).

Job Interest



Education Information

Type of school Name and Location Years Completed Major Course of Study Graduated (Yes or No) Degree
High School
College/University
Graduate School
Technical/Business

Please list any job related professional, trade, business or civic activities, organizations, and associations in which you participated, or of which you are a member. (You may omit those that indicate race, color, religion, political affiliations, national origin, ancestry, disability, marital status, sex, or age.)

Job-Related Skills or Experience

Employment History

Starting with your most recent job, accurately list ALL jobs you have held in the past ten (10) years. Give correct addresses and telephone numbers. Include volunteer experience.

1.



2.



3.


References

Please provide the names, addresses, and telephone numbers of at least two (2) professional references who are not related to you.

1.

2.

3.

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING BELOW

We greatly appreciate your interest in our organization. Please be advised that applicants are considered for all positions without regard to race, age, color, sex, religion, national origin, disability, marital or veteran status. For consideration for employment with us, the application must be completed in its entirety and signed by you.

This application will remain open for consideration for the position for which you applied for ninety (90) days from today’s date. If you wish to be considered for this position or another position after ninety days from this date, you will need to complete and submit another application.

I certify that the answers given by me are true and correct without omissions of any kind whatsoever, and that intentional falsification of information given will be grounds for disciplinary action, up to and including termination.

I understand any offer of employment may be contingent upon a credit, criminal or other types of background checks, including a drug screening. I hereby authorize all references and former employers listed on my employment application to give the company any and all information concerning my previous employment and any pertinent information they might have, personal or otherwise, and release all parties from any claims, causes of action, or liability from damages that may or could result in furnishing such information to the company.

I understand that if hired, the employment relationship is at-will. This means that either 8-2-8 Urgent Care or I may terminate the employment relationship at any time, for any or no reason.

UNDER CALIFORNIA LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.

8-2-8 URGENT CARE IS AN EQUAL OPPORTUNITY EMPLOYER