1 Personal Information
2 Job Interest
3 Education
4 Employment History
5 References
6 Applicant's Statement

Personal Information

If you need any special accommodations to participate in this process (i.e., assistance in completing the applications, accommodations for the interview or any job-related testing, etc.) please let us know immediately, and/or at the time of any follow-up appointment(s).

Legal Last Name is required.
Legal First Name is required.
Middle Initial is required.
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Please provide a valid date available to start work.
Home phone number is required.
Mobile phone is required.
Address is required.
City is required.
State is required.
Zip Code is required.
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If no, you will need to provide a work permit and/or age certificate upon offer of employment.

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(In accordance with the Immigration Reform and Control Act of 1986, any offer of employment is conditioned upon satisfactory proof of an applicant’s identity and legal ability to work in the United States)

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Job Interest

Please provide a valid date available to work.
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Education

School Name and Address of School Course of Study No. of Years/Completion Date Diploma/Degree
High School
Undergraduate College
Graduate/Professional
Other (Specify)

Employment History

Starting with your most recent job, accurately list ALL jobs you have held in the past ten (10) years. Give correct addresses and telephone numbers. Include volunteer experience. Ask for additional pages as needed.

Employment 1

References

Name Address Title / Company Phone Number

Applicant's Statement

Please read the following carefully before signing below

We greatly appreciate your interest in our organization. Please be advised that applicants are considered for all positions without regard to race, age, color sex, religion, national origin, disability, marital or veteran status. For consideration for employment with us, the application must be completed in its entirety and signed by you.

Applicant's Statement

I certify those answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time-period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with A&E Healthcare Services is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also that I am required to abide by all rules and regulations of the employer.

Under Maryland law, an employer may not require or demand, as a condition of employment, prospective employment, or continued employment, that an individual submit to or take a lie detector or similar test. An employer who violates this law is guilty of a misdemeanor and subject to a fine not exceeding $100.

Signature of Applicant

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