Are you over 18 years of age?

Yes

No

Have you previously worked for PracticeForces?

Yes

No

Do you know anyone that has worked for PracticeForces?

Yes

No

Are you related to anyone in our employ?

Yes

No

Do you have any commitments (including non-compete agreements) to another entity, business, or person that might affect your employment with Practiceforces?

Yes

No

Previous Employment | Most Recent Employer

List all places of employment over the past ten years, including military service. Please account for all self- employment and gaps in employment.

If you have had more than 4 employers in the last 10 years, ask for an additional form. Resumes may be submitted but cannot be used in lieu of completing this section of the application.

Are You Currently Employed?

Yes

No

Previous Employer #2

Employer Company Name
Dates Employed
Your Job Title/Position
Duties
Employer's Company Address
Your Supervisor's Name
Supervisor Phone
Reason For Leaving
May We Contact Your Previous Employer

Previous Employer #3

Employer Company Name
Dates Employed
Your Job Title/Position
Duties
Employer's Company Address
Your Supervisor's Name
Supervisor Phone
Reason For Leaving
May We Contact Your Previous Employer

Previous Employer #4

Employer Company Name
Dates Employed
Your Job Title/Position
Duties
Employer's Company Address
Your Supervisor's Name
Supervisor Phone
Reason For Leaving
May We Contact Your Previous Employer

Education

High School Education

Name/Address School
Course or Major
Diploma/Degree
Dates Attended From

College Education

Name/Address School
Course or Major
Diploma/Degree
Dates Attended From

Trade/Other Education

Name/Address School
Course or Major
Diploma/Degree
Dates Attended From

Professional References

PROFESSIONAL REFERENCES (Do NOT use relatives or previous Co Workers / Friends, Supervisory references ONLY):

Reference #1

Name
Address
Phone
Business
Years Acquainted

Reference #2

Name
Address
Phone
Business
Years Acquainted

Emergency Contact

In case of emergency notify:

Name
Address
Relationship
Phone

Questionairre

Do you smoke?

Yes

No

If yes, can you refrain from smoking during the workday?

Yes

No

If you are applying for a position that requires state or national registration, certification or license, you must furnish us with current proof of registration, certification or license (use additional forms if necessary).

Certification or License Type
Certification or License Number
Year
State

Are you eligible to work in the U.S.?

(Proof of eligibility will be required before you can be employed)

Yes

No

Have you ever committed or been convicted of a crime, entered a plea of nolo contendere (no contest) to a crime, had adjudication withheld or received a suspended sentence (regardless of the ultimate adjudication) for a crime?

Yes

No

Are you now on probation?

Yes

No

Do you have any criminal charges currently pending?

Yes

No

Applicant must execute the attached Affidavit of Good Moral Character for purposes relevant to §400.512, Florida Statutes.

Have you ever been sued for causing a death of, or injury or damage to any person, or for causing destruction of, or damage to property?

Yes

No

Note: A “yes” answer to the above questions will not necessarily disqualify you from employment. The nature, severity, and date of the offense(s) or incident(s) will be considered in relation to the position for which you are applying.

Please review the job description for the position for which you are applying. Are you able to perform the essential job-related functions for the position with or without reasonable accommodation?

Yes

No

Upload Resume

I certify that all of the information I have provided in order to apply for and secure work with the employer is true, complete and correct.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references, employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.
I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.
I understand that this application remains current for 90 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same rights to terminate my employment at any time, with our without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specific period or defined duration. I understand that no supervisor or representative of the employer is authorized to make any assurance to the contrary and that no implied, oral or written agreements contrary to the foregoing expressed language are valid unless they are in writing and signed by the employer’s president.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service whenever it is discovered.
I authorize investigation of all statements contained in this application.

Do you certify that you have read, fully understand and accept all terms of the foregoing Applicant Statement?

Yes

No

Today's Date

Signature

Clear