Personnel application

* We consider applicants for all positions without regard to race, color, religion, national origin, or any other legally protected status

Education
High School
City/State
Did you graduate?
- Yes
- No
Degree received
Major
If No, # of years left to graduate*
If Yes, date of Graduation*
GED
City/State
Did you graduate?
- Yes
- No
Degree received
Major
If No, # of years left to graduate*
If Yes, date of Graduation*
Other School
City/State
Did you graduate?
- Yes
- No
Degree received
Major
If No, # of years left to graduate*
If Yes, date of Graduation*
College
City/State
Did you graduate?
- Yes
- No
Degree received
Major
If No, # of years left to graduate*
If Yes, date of Graduation*
Other credentials/ licenses/ professional affiliations, etc., which are relevant to the job(s) for which you are applying:
City/State
License/ Certificate #
SKILLS: Please list technical skills, clerical skills, trade skills, etc., relevant to this position.

REFERENCES: NO personal references please..
(3 prior professional references with 1 supervisor/manager related reference required)
Reference Name
Reference Phone
Reference Email Address
Relationship
Address
Street Address City State / Province / Region ZIP / Postal Code
Reference Name
Reference Phone
Reference Email Address
Relationship
Address
Street Address City State / Province / Region ZIP / Postal Code
Reference Name
Reference Phone
Reference Email Address
Relationship
Address
Street Address City State / Province / Region ZIP / Postal Code

Applicant’s Statement
The information provided on this Application for Employment is true, correct, and complete. It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or termination from employment if I am subsequently employed. I give Criticare Lancaster, Inc. the right to investigate all references and to secure additional information about me, including criminal background clearance, child abuse clearance, FBI clearance, professional license verification, etc. as deemed necessary and appropriated by the Company for the position(s) for which I am applying. I hereby release from liability, Criticare Lancaster, Inc. and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. Criticare Lancaster, Inc. is an Equal Opportunity Employer.
Type your name to sign

Personal Information