Brookhaven Marketplace is an equal employment opportunity employer. Our company will provide reasonable accommodations with the application process upon your request consistent with applicable laws.

Personal Information:

Address:

Employment Desired:


Availability:

(Please list your availability to work)

MON

TUES

WED

THURS

FRI

SAT

SUN


Education:

NAME & LOCATION OF SCHOOL




Employment Experience:

(Please list your employment experience, starting with the most recent first.)

(Brookhaven Marketplace will only contact current employer only if you consent. Our Company reserves the right to contact the other employers listed without any further notice to you.)


Dates of Employment
Month & Year

Employer Name
Address
Phone

Salary

Position/Duties

Reason for Leaving





General Information:


References:

Name

Address

Phone Number

Business

Relationship

PLEASE READ CAREFULLY BEFORE SIGNING

I certify that all the information submitted by me on this application is true, correct and complete. I understand that if any false information, omissions, or misrepresentations on this form or provided in any interview are discovered, my application may be rejected, and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company’s rules, regulations and Supervisor’s directions. I understand that this Application forEmployment and other Company documents are not contracts of employment. I agree that if I am employed, my employment is at-will, and that my employment, compensation or benefits can be changed or terminated, with or without cause or reason, and with or without notice, at either my or the company’s option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause or reason, and with or without notice, at any time by the company. I understand that no company representative, other than the President, and then only in writing and signed by both of us, has any authority to enter into any agreement foremployment for any specific period of time or to make any agreement contrary to the forgoing. I further authorize the Company to investigate my references, personal history, work record, and other matters related to my suitability for employment, as well as credit or criminal records checking. I authorize all of this information to be provided to the company or their agent and release them from any and all claims, demands or liability arising out of or in any way related to such investigation or disclosure. I understand that if hired, I may be required to pass a criminal history records check. Also, if required, I agree to complete, fully participate in and pass a drug and/or alcohol test. Please note that this application is considered current for 30 days. After 30 days, it is necessary to complete another application form to be considered for employment

Date:

10/17/2019

By providing your name in the above box, you are signing this document.