Personal References (List 3 - excluding former employers or relatives)
 
Name & Occupation

Address

Phone

 
 
 
 
Person to be notified in case of an emergency
 
Name _________________________ Phone Number _____________________
 
 
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements, misleading statements, or omissions on this application shall be considered sufficient cause for dismissal. I hereby authorize Community Counseling Center to thoroughly investigate my references, work records, education and other matters related to my suitability for employment and further, authorize my current and former employers to disclose to the company any and all letters, reports and other information pertaining to my employment with them, without giving me prior notice of such disclosure. In addition, I hereby release Community Counseling enter, my current and former employers, and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the application or conveyed to me during any interview which may be granted is intended to create an employment contract, implied or explicit, between me and Community Counseling Center. In addition, I understand and agree that if I am employed, my employment relationship with Community Counseling Center is strictly voluntary and at our mutual will. I understand that if employed, my employment is for no definite period and may be terminate any time, with or without prior notice, with or without cause or reason, at the option of either myself or Community Counseling Center, and that no promise or representations contrary to the foregoing are binding on Community Counseling Center unless made in writing and signed jointly by the Executive Director and myself.

 
Signature of Applicant _______________________ Date ___________________
 
 
 
 

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