PSI

Preliminary Employment Application
Note: This is a Preliminary Application. To be considered for employment, I understand that I must complete an official Company Application.
The Company is an equal opportunity employer. The Company does not discriminate because of race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, family responsibilities, physical or mental disability, matriculation, or political affiliation.
Personal Information
First Name*  Last Name*
Street Address: Apt#: 
City* State* 
Zip Code* email* 
Evening Phone #: - - Daytime  Phone # - -
Education Subjects/Field of Study
Licenses/Certifications  1. 2.   3.
Employment Desired
Position
Desired Salary: $      per Hours: 
Employment History     (Please enter most recent employment first)
Job 1
Company Name: Job Title: 
Duration of employment: Start Date (MM/YY):  / End Date (MM/YY): /
Brief description of duties
Salary: $ .   per Reason for leaving:
Job 2
Company Name:  Job Title: 
Duration of employment: Start Date (MM/YY):  / End Date (MM/YY): /
Brief description of duties
Salary: $ .   per  Reason for leaving:
Job 3
Company Name: Job Title: 
Duration of employment: Start Date (MM/YY):  / End Date (MM/YY): /
Brief description of duties
Salary: $ .   per Reason for leaving:
Submit Application

APPLICANT’S STATEMENT

  • I understand that The Company follows an "employment at will" policy, which means that I or the company may terminate my employment at any time, for any reason consistent with applicable state or federal law. This "employment at will" policy cannot be changed unless the change is specifically authorized in writing by the Chief Executive Officer of this organization.

  • I understand that this preliminary application is not a contract of employment.
  • I understand that if I am offered a job, federal law requires me to submit satisfactory proof of employment authorization and identity. If I do not do, the offer will be withdrawn.
  • I understand that this preliminary application will be active for a period of 90 days.
  • I understand that The Company has a drug and alcohol policy that includes pre-employment screening for drugs and alcohol. If I fail this screening, or fail or refuse to be tested, I will not be offered a job. In addition, I understand that random screening is a condition for continued employment.
  • I understand that state and/or federal regulations require background checks for convictions of certain crimes, and that a plea of guilty or a conviction will not necessarily be a bar to employment. Factors such as the date of the offense, your age at the time, nature of the violation, and rehabilitation will be taken into account. I also understand that the company will check to see if I have any history of child or client abuse or neglect and that I may not be hired for or remain in certain jobs if I have such a history.
  • This is not an official Company application. To be considered for employment I understand that I must complete an official Company Application.
  • I certify that I have read this form in its entirety and that the information herein provided is true, accurate and complete to the best of my knowledge. I understand that, if any statement I have made in this preliminary application is false, misleading or erroneous, regardless of when discovered, it may result in rejection on my application or in my discharge if I have been employed.
  • By Submitting this Preliminary Application, I am agreeing to the Terms stated above