AT-WILL EMPLOYMENT

The relationship between you and the A-1 Rehab & Recruitment is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the A-1 Rehab & Recruitment. No representative of A-1 Rehab & Recruitment has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your atwill employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.

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EMPLOYMENT APPLICATION

A-1 Rehab & Recruitment is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.
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Applicant Information

Applicant Name*:

Address*:

City & State*

Zip Code*:

Telephone Number*:

Email Address*:

Date of Application:

Employment Position

Position(s) applying for:

How did you hear about this position?

What days are you available for work:

What hours or shift are you available for work?

On what date can you start working if you are hired?

Personal Information

Have you ever applied to or worked for A-1 Rehab & Recruitment?

Yes No

If yes, when?

Do you have any friends, relatives, or acquaintances working for A-1 Rehab & Recruitment?

Yes No

If yes, state name & relationship:

Are you 18 years of age or older?

Yes No

Are you a U.S. citizen or approved to work in the United States?

Yes No

What document can you provide as proof of citizenship or legal status?

Do you have any condition which would require job accommodations?

Yes No

If yes, please describe accommodations .

Job Skills/Qualifications

Please enter the skills and qualifications you possess for the position for which you are applying:

(Note: A-1 Rehab & Recruitment complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional. )

Education and Training

High School

Name

Location (City, State)

Degree Earned

College/University

Name

Location (City, State)

Degree Earned

Vocational School/Specialized Training

Name

Location (City, State)

Degree Earned

Military

Are you a member of the Armed Services?

What branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

Previous Employment

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

References: Please provide 3 personal and professional reference(s) below:

Reference

Contact Information

Reference

Contact Information

Reference

Contact Information

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Application Form

AT-WILL EMPLOYMENT

EMPLOYMENT APPLICATION

Applicant Information

Employment Position

Personal Information

Job Skills/Qualifications

Education and Training

High School

College/University

Vocational School/Specialized Training

Military

Previous Employment

References: Please provide 3 personal and professional reference(s) below: