Employment Application

Applicant's name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Phone *

Position(s) applying for *

Email *

Desired salary *

How did you learn about TMD? *

Advertisement
Employment Agency
Employee Referral
Other

Have you applied for a position with us before? *

Yes
No

Have you ever been employed with us before? *

Yes
No

Are you currently employed? *

Yes
No

Are you available to work (select all that apply): *

Full time
Part time
All shifts
Temporary

Can you travel for work if necessary? *

Yes
No

Are you legally permitted to work in the United States? (Proof of eligibility will be required within three (3) working days of employment.) *

Yes
No

Have you ever gone by a name other than the one listed above? *

Yes
No

If yes, by what name?

Education

of ever Please

List the last three (3) schools attended.

Name of first school / institution *

Degree / Major / Minor *

Location *

G.P.A. *

Years completed *

Diploma obtained? *

Yes
No

Name of second school / institution

Degree / Major / Minor

Location

G.P.A.

Years completed

Diploma obtained?

Yes
No

Name of third school / institution

Degree / Major / Minor

Location

G.P.A.

Years completed

Diploma obtained?

Yes
No

Military Service

Have you ever served in the U.S. military? *

Yes
No

If yes, what branch did you serve in?

References

Please list three (3) personal and/or professional references.

Name (Reference 1) *

Name (Reference 2) *

Name (Reference 3) *

Phone / Email *

Years known *

Applicant’s Statement:
I certify that the information provided in this application is true, to the best of my knowledge.

I understand that providing false or misleading information at any time during the application and interview process may lead to refusal to hire or discharge from TMD. If I become employed by TMD, I agree to follow all of TMD’s rules and regulations as they develop and change.

I allow TMD to conduct investigations on me, my background and my performance, and am aware that such investigations will become a part of my employment record. With this, I authorize TMD to speak with my acquaintances, personal and professional, to gather information about me.

I authorize all former employers and references to provide any information about me to TMD, and release them of liabilities and damages of all kinds for providing this information. I authorize TMD to verify the accuracy of the information within this application. I also authorize the release of my educational transcripts to TMD for education verification purposes.

I release TMD from liability for collecting information about me and using it to make employment decisions.

If I become employed by TMD, I understand that the employment relationship will be “at will”.

This application for employment is valid for the next 90 days. I understand that if I wish to be considered for employment after this period of time, I must apply again.

Date *

Signature *

Clear Signature

Please upload a cover letter and your current resume. *

Click or drag files to this area to upload. You can upload up to 3 files.