THE SPORTS MEDICINE RESEARCH AND TESTING LAB

Employment Application

An Equal Opportunity Employer. No question is asked for the purpose of excluding any applicant due to race, color, national origin, religion, age, sex, or disability. This employer participates in E-Verify.

APPLICANT INFORMATION
Last Name  First  M.I.  Date 12/17/2018
Street Address  Apartment/Unit # 
City     State  Zip
Phone  E-mail Address 
Cell Phone  Date Available  Desired Salary 
Position Applied for 
Are you at least 18 years old Yes No   If hired, can you furnish proof that you are
authorized to work in the U.S.?
Yes No  
Have you ever worked for this company? Yes No   If so, when? 
Have you ever been convicted of a felony? Yes No   If yes, explain 

EDUCATION
High School  Address 
From        To  Did you graduate  Yes No  
College   Address 
From        To  Did you graduate  Yes No Degree 
Other       Address 
From        To  Did you graduate  Yes No Degree 
Other       Address 
From        To  Did you graduate  Yes No Degree 

REFERENCES
Please list three professional references.
Full Name  Relationship 
Company   Phone 
Address    
Full Name  Relationship 
Company   Phone 
Address    
Full Name  Relationship 
Company   Phone
Address    

PREVIOUS EMPLOYMENT
Company   Phone 
Address     Supervisor 
Job Title     Starting Salary $ Ending Salary $
Responsibilities 
From  To   Reason for Leaving 
May we contact your previous supervisor for a reference?   Yes No
Company  Phone
Address   Supervisor 
Job Title   Starting Salary $ Ending Salary $
Responsibilities 
From  To  Reason for Leaving 
May we contact your previous supervisor for a reference? Yes No
Company  Phone  
Address   Supervisor 
Job Title   Starting Salary $ Ending Salary $
Responsibilities 
From  To  Reason for Leaving 
May we contact your previous supervisor for a reference?  Yes No

MILITARY SERVICE
Branch  

 From             To      

Rank at Discharge   Type of Discharge 
If other than honorable, explain 

APPLICANT AGREEMENT
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 agree to take a job related physical examination or a drug/alcohol test when requested as a condition of employment. I agree to comply with all rules of the company as a condition of employment. In the event the company advances me money or other things of value, I agree to repay the company and also that any amount still owing may be deducted from my final paycheck.
Signature of applicant  Date 12/17/2018