Synergy Application - SYNERGY LLC

Postion Applying for

First Name

Middle Initial

Last Name

Street Address

City

State

Zipcode

Phone Number

Date you can start work

Salary Desired

Do you have a High School Diploma or GED?

Yes No

Hours

Full Time Part Time

Are you able to work Days and Nights when required?

Yes No

Are you able to travel if needed?

Yes No

Are you able to work in the US on an unrestricted basis?

Yes No

Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment)

Yes (Please explain below) No

If the answer above was "Yes" please explain here

Job Title - Most Recent

Start Date

End Date

Company Name

Supervisors Name

Company Phone Number

Job Description

Reason for Leaving

Ending Salary

Job Title - Previous

Start Date

End Date

Company Name

Supervisors Name

Company Phone Number

Job Description

Reason for Leaving

Ending Salary

Resume - Please upload your current resume if you have one available

Consent

I certify that the facts set forth in this application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application for employment and release the Employer from any liability. The Employer may contact any listed references on this application. I acknowledge and understand that the company is an "at will" Employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the Employer may terminate the employement relationship with any employee at any time, with or without cause, with or without notice to the other party.