Please list your last three employers, starting with the most recent. Please describe your situation if there are any periods of unemployment in your history. If self-employed, list your company’s name and business references.
Most Recent Employer
Please list references from your last 3 employers, starting with the most recent. If self-employed, list your company’s name and
business reference. If there is a period of unemployment, list a reference that is unrelated to you for that period of time.
Please read each paragraph carefully, initial each paragraph, and sign below. Your initials signify that you have read,
understood and agreed to the provisions initialed.
This employer takes very seriously false or misleading information provided by applicants on a job application, resume, and other application related materials, including statements made in job interviews. Any representation made by a job applicant that contains false or misleading information, or omits significant information, will result in employer’s refusal to hire the applicant or, if discovered after employment commences, will be grounds for immediate termination of employment. My initials below, and signature on this application, certify that this application was completed by me, and that all information contained in my application is true and correct.
I hereby authorize the references I have listed to provide information to employer relevant to my application for employment, including information regarding my current and/or previous employment. In addition, I hereby agree to release all persons, schools, and employers of any and all claims, demands or liabilities arising out of, or in any way related to such disclosure. For positions within the City of San Francisco, pursuant to the San Francisco Fair Chance Ordinance, the employer will consider qualified applicants with arrest and conviction records for employment. For positions for work within the City of Los Angeles, pursuant Los Angeles’s Fair Chance Initiative for Hiring Ordinace (FCIHO), the employer is prohibited from inquiring into a job applicant’s criminal history before making a confidential offer of employment to the applicant whereby this request to provide information is not for any information directly or indirectly for criminal history information.
If hired, I understand and agree I may terminate my employment with employer at any time, for any reason or no reason, with or without notice to employer, and that employer may terminate my employment at any time, for any reason or no reason, with or without notice to me. If hired, I understand and agree that my employment with employer is for no specified term. No one other than
employer has the authority to alter this policy of “at-will” employment, and that any change of that policy must be in writing and signed by an authorized company representative. This at-will provision supersedes all prior understandings or agreements regarding the nature of any employment relationship with employer.
This employer is an equal opportunity employer. This employer does not discriminate on the basis of race, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), color, national origin, sexual orientation, religion, age, disability, marital status, protected medical condition, gender, gender expression, gender identity, genetic information, or any other basis as defined by state, federal or local law. This employer provides reasonable accommodation to qualified individuals with disabilities in both the hiring process and during employment as required by applicable federal, state and local laws.
This Employment Application was reviewed for legal accuracy and updated in 2018 by Zaller Law Group PC.