Employment - Illinois Eye Center - Total Eye Care Solutions in Central Illinois

Personal Information

First Name *

Last Name *

Address *

City *

State *

Zip *

Phone with area code *

Referred by

Maiden Name (if applicable)

Employment Desired

Position *

Date you can start *

Are you employed? Yes No *

If so, may we enquire of your present employer? Yes No

Ever applied to this company before? Yes No *

If so, when?

Skills Relevant to Position Applying For *

Thank you! Your application has been successfully submitted.

High School Name *

High School Location *

Did you graduate? Yes No *

College Name

College Location

Did you graduate? Yes No

Major

Trade or Business School

Trade or Business School Location

Did you graduate? Yes No

Major

Former Employers

List last four starting with last one first.

Most Recent Employer Name *

Address

Phone

Start Date

End Date

Position

Reason for Leaving

2nd Most Recent Employer Name *

Address

Phone

Start Date

End Date

Position

Reason for Leaving

3rd Most Recent Employer Name *

Address

Phone

Start Date

End Date

Position

Reason for Leaving

4th Most Recent Employer Name *

Address

Phone

Start Date

End Date

Position

Reason for Leaving

References

Names, phone numbers, and years known of 3 non-related people. *

Resume

I understand you may not interview me today, and hiring decisions are not always made instantly. I also understand the Illinois Eye Center does not hire everyone who applies for any position, and that the Illinois Eye Center does not discuss it’s hiring decisions with applicants. I will be called if there is a job for me.

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements or omissions on this application shall be grounds for dismissal.

I authorize the Illinois Eye Center to contact, obtain, and verify the accuracy of information contained in this application from previous employers, educational institutions and references. I also release the Illinois Eye Center from all liability for any damage that may result from utilization of such information.

I understand that this application does not constitute an agreement or contract for employment and that there is no specified length of employment should I become employed at the Illinois Eye Center. Furthermore, either I or the Illinois Eye Center can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

I understand that it is the policy of the Illinois Eye Center not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that persons need for a reasonable accommodation as required by the Americans with Disabilities Act. The Illinois Eye Center is an Equal Opportunity Employer.

I have read and fully understand the above statements, and I seek employment under these conditions. *

Thank you! Your form has been successfully submitted.

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Employment Form

Personal Information

Employment Desired

Former Employers

References