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Therapeutic Kneads EMPLOYMENT APPLICATION
Today’s Date:
MM slash DD slash YYYY
First
Middle
Last
Preferred Name/Nickname
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Home Phone
*
Alternate/Work Phone
*
Email Address
*
PLEASE PLACE A CHECK BY YOUR RESPONSE OR PROVIDE THE APPROPRIATE INFORMATION
Are you interested in:
Full Time
Part Time
Temporary
What schedule would you prefer?
Weekdays
Weekends
Evenings
Nights
How did you hear about the position?
Classified Ad
Friend
Radio
Internet
Desired Pay:
Hourly Pay (Minimum, if applicable)
Annual Pay:
Minimum
Desired
When are you able to start work?
MM slash DD slash YYYY
PLEASE CHECK YES OR NO TO THE FOLLOWING:
In what local area do you prefer to work?
Position desired:
Are you authorized to work in the United States?
Yes
No
Federal law requires that employers hire only individuals who are authorized to be lawfully employed in the United States. In compliance with these laws, Therapeutic Kneads, Ltd. will verify the status of every individual offered employment with the Company. In this connection, all offers of employment are subject to verification of the applicant’s identity and employment authorization, and it will be necessary for you to submit such documents as are required by law to verify your identification and employment authorization.
Are you under 18 years of age?
Yes
No
If yes, can you furnish a work permit?
Yes
No
Therapeutic Kneads, Ltd
. is an equal opportunity employer and does not discriminate against any applicant or employee because of race, color, religion, sex, national origin, disability, age, or military or veteran status in accordance with federal law. In addition,
Therapeutic Kneads, Ltd
.complies with applicable state and local laws governing non‑discrimination in employment in every jurisdiction in which it maintains facilities
Therapeutic Kneads, Ltd
also provides reasonable accommodation to qualified individuals with disabilities in accordance with applicable laws.
Are you capable of performing the essential functions of the job for which you are applying with or without a reasonable accommodation?
Yes
No
PLEASE LIST YOUR WORK EXPERIENCE BELOW (MOST RECENT JOB FIRST)
Massachusetts applicants
may include any verified work performed on a volunteer basis.
From
Month
Day
Year
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Month
Day
Year
COMPANY NAME:
YOUR POSITION and TITLE:
SUPERVISOR’S NAME, TITLE and POSITION:
NO. & STREET:
CITY:
ZIP CODE:
STATE:
SUPERVISOR’S TELEPHONE NUMBER:
TYPE OF BUSINESS:
STARTING PAY:
FINAL PAY:
TERMINATION:
VOLUNTARY
INVOLUNTARY
REASON:
BRIEFLY DESCRIBE YOUR MAJOR DUTIES AND REASON(S) FOR TERMINATION
BRIEFLY DESCRIBE YOUR
MAJOR DUTIES
AND
REASON(S) FOR TERMINATION
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COMPANY NAME:
YOUR POSITION and TITLE:
SUPERVISOR’S NAME, TITLE and POSITION:
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CITY:
ZIP CODE:
STATE:
SUPERVISOR’S TELEPHONE NUMBER:
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TERMINATION:
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INVOLUNTARY
TELEPHONE NUMBER:
REASON:
BRIEFLY DESCRIBE YOUR MAJOR DUTIES AND REASON(S) FOR TERMINATION
BRIEFLY DESCRIBE YOUR
MAJOR DUTIES
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REASON(S) FOR TERMINATION
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COMPANY NAME:
SUPERVISOR’S NAME, TITLE and POSITION:
YOUR POSITION and TITLE:
NO. & STREET:
CITY:
ZIP CODE:
STATE:
SUPERVISOR’S TELEPHONE NUMBER:
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STARTING PAY:
FINAL PAY:
TELEPHONE NUMBER:
TERMINATION:
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INVOLUNTARY
REASON:
BRIEFLY DESCRIBE YOUR MAJOR DUTIES AND REASON(S) FOR TERMINATION
BRIEFLY DESCRIBE YOUR
MAJOR DUTIES
AND
REASON(S) FOR TERMINATION
From
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Day
Year
To
Month
Day
Year
COMPANY NAME:
SUPERVISOR’S NAME, TITLE and POSITION:
YOUR POSITION and TITLE:
NO. & STREET:
CITY:
ZIP CODE:
STATE:
SUPERVISOR’S TELEPHONE NUMBER:
TYPE OF BUSINESS:
STARTING PAY:
FINAL PAY:
TELEPHONE NUMBER:
TERMINATION:
VOLUNTARY
INVOLUNTARY
REASON:
BRIEFLY DESCRIBE YOUR MAJOR DUTIES AND REASON(S) FOR TERMINATION
BRIEFLY DESCRIBE YOUR
MAJOR DUTIES
AND
REASON(S) FOR TERMINATION
EDUCATION:
HIGH SCHOOL OR PREP
NAME AND ADDRESS OF SCHOOL
MAJOR SUBJECT
DID YOU GRADUATE?
TYPE OF DEGREE OR DIPLOMA
COLLEGE
MAJOR SUBJECT
DID YOU GRADUATE?
TYPE OF DEGREE OR DIPLOMA
COLLEGE OR GRADUATE
MAJOR SUBJECT
DID YOU GRADUATE?
TYPE OF DEGREE OR DIPLOMA
OTHER
MAJOR SUBJECT
DID YOU GRADUATE?
TYPE OF DEGREE OR DIPLOMA
PROFESSIONAL DESIGNATIONS:
DESIGNATION
ORGANIZATION GRANTING DESIGNATION
DATE COMPLETED
DESIGNATION
ORGANIZATION GRANTING DESIGNATION
DATE COMPLETED
PROFESSIONAL LICENSES:
TYPE OF LICENSE
STATE GRANTING LICENSE
LICENSE NUMBER
TYPE OF LICENSE
STATE GRANTING LICENSE
LICENSE NUMBER
REFERENCES:
Please list three professional references
Name
RELATIONSHIP
COMPANY
PHONE/ALTERNATE PHONE
Name
RELATIONSHIP
COMPANY
PHONE/ALTERNATE PHONE
Name
RELATIONSHIP
COMPANY
PHONE/ALTERNATE PHONE
I have submitted the attached form to the company for the purpose of obtaining employment. I acknowledge that the use of this form, and my filling it out, does not indicate that any positions are open, nor does it obligate the company to further process my application.
My signature below attests to the fact that the information that I have provided on my application, resume, given verbally, or provided in any other materials, is true and complete to the best of my knowledge and also constitutes authority to verify any and all information submitted on this application. I understand that any misrepresentation or omission of any fact in my application, resume or any other materials, or during any interviews, can be justification for refusal of employment, or, if employed, termination from the Company’s employ.
I also affirm that I have not signed any kind of restrictive document creating any obligation to any former employer that would restrict my acceptance of employment with the Company in the position I am seeking.
I understand that this application is not an employment contract for any specific length of time between the Company and me, and that in the event I am hired, my employment will be “at will” and either the Company or I can terminate my employment with or without cause and with or without notice at any time. Nothing contained in any handbook, manual, policy and the like, distributed by the Company to its employees is intended to or can create an employment contract, an offer of employment or any obligation on the Company’s part. The Company may, at its sole discretion, hold in abeyance or revoke, amend or modify, abridge or change any benefit, policy practice, condition or process affecting its employees.
References
: I hereby authorize the company and its agents to make such investigations and inquiries into my employment and educational history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, and other persons from all liability in responding to inquires connected with my application and I specifically authorize the release of information by any schools, businesses, individuals, services or other entities listed by me in this form. Furthermore, I authorize the company and its agents to release any reference information to clients who request such information for purposes of evaluating my credentials and qualifications.
Temporary/Contract Employment
: If employed as a temporary or contract employee, I understand that I may be an employee of the company and not of any client. If employed, I further understand that my employment is not guaranteed for any specific time and may be terminated at any time for any reason. I further understand that a contract will exist between the company and each client to whom I may be assigned which will require the client to pay a fee to the company in the event that I accept direct employment with the client, I agree to notify the company immediately should I be offered direct employment by a client (or by referral of the client to any subsidiary or affiliated company), either for a permanent, temporary (including assignments through another agency), or consulting positions during my assignment or after my assignment has ended.
SIGNED:
DATE:
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