Application for Employment

White Wolf Dental is an equal opportunity employer and does not discriminate on the basis of race, religion, color, national origin, age, sex, gender, disability, or any other reason prohibited under Federal, State, or local laws.

Contact Information

Name:

  

Other Names Used: 

Address:

  

Phone:  

Email Address: 

Questions About Applicant

Position Desired: 

Salary/Wage Desired: 

Date Available: 

Type of Employment Desired: 

Are you legally eligible for employment in the United States? 

(Proof of U.S. Citizenship or immigration status will be required upon Employment)

Are you 16 years of age or older? 

Have you applied here before? 

If you have applied here before, when did you apply? 

How did you hear about this position? 

Have you ever been convicted of, or pled guilty or no contest to, a crime other than a minor traffic violation? 

If yes, please explain in detail in a separate document and attach below. Include the date of final disposition of the case and the nature of the offense. You do not have to include any convictions or court records that have been sealed or exempted by a valid court order. This information will not necessarily disqualify you from employment, but false or misleading information will. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account.

Explanation of criminal history: 

Educational Background

Highest level of education completed: 


College/University/Trade School: 

City & State: 

Degree or Diploma: 

Major: 

Date of Graduation: 

College/University/Trade School: 

City & State: 

Degree or Diploma: 

Major: 

Date of Graduation: 

College/University/Trade School: 

City & State: 

Degree or Diploma: 

Major: 

Date of Graduation: 


Have you served in the U.S. Military?       Branch: 

Rank:  Dates of Service: From  To 

Select Discharge Type: 

Employment History

List all positions held, including part-time, summer and/or volunteer work and periods of employment. Do not omit any employers. Explain any gaps in employment in comment section. If you are submitting a resume, you are still required to provide the requested information in the space provided.

Employer Name:  Phone Number: 

May we contact?:  

Address:

  

Dates of Employment:  to 

Starting Salary:   Ending Salary:  

Reason For Leaving: 

Responsibilities: 

Employer Name:  Phone Number: 

May we contact?:  

Address:

  

Dates of Employment:  to 

Starting Salary:   Ending Salary:  

Reason For Leaving: 

Responsibilities: 

Employer Name:  Phone Number: 

May we contact?:  

Address:

  

Dates of Employment:  to 

Starting Salary:   Ending Salary:  

Reason For Leaving: 

Responsibilities: 

Special Training and Skills

Please list languages spoken, other than English:

Please list pertinent skills, special training, and equipment you are trained to operate:

Please list any other accomplishments, awards, professional groups of which you are a member, or additional information you would like us to consider:



List name and telephone number of three professional/work references who are not related to you.

1.  


2.  


3.  


I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I further understand that any employment that is offered to me will be at­will and that this application does not create or imply a contract for employment.

 

Notice & Acknowledgement of Binding Arbitration

(This form is to be signed by all applicants for employment)

White Wolf Dental (hereinafter “Employer”) cares about its employees and the working environment we all share. As such, Employer has adopted an Alternative Dispute Resolution Procedure for the resolution of all workplace disputes as a policy, and condition of employment. By signing this application and acknowledgment you are agreeing to settle any and all previously unasserted claims, disputes or controversies arising out of or relating to your application or candidacy for employment, employment and/or cessation of employment with Employer, exclusively by final and binding arbitration before a neutral Arbitrator. You are also acknowledging that should you be hired you understand that you will be bound by the terms of this policy. By way of example only, such claims include claims under federal, state and local statutory or common law, such as Age Discrimination in Employment Act, Title VII of the Civil Rights Act or 1964, as amended, including the amendments of the Civil Rights Act of 1991, the Americans with Disabilities Act, the law of contract and the law of tort. I understand that this policy does not, however, in any way alter the “at will” status of my employment with Employer should I be hired which, unless otherwise agreed upon by written contract, is not for a fixed term or definite period and may be terminated at the will of myself or Employer with or without notice and without resort to this policy.


 

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