WALDEN
HELP FOR TODAY    HOPE FOR TOMORROW

APPLICATION FOR EMPLOYMENT
(PRE-EMPLOYMENT QUESTIONNAIRE)

WSI is an equal opportunity employer and does not discriminate on the basis of race, color, sex, age, national origin, religion, marital status, sexual orientation or physical or mental disability in matters affecting employment, services or in providing access to programs.
 
NAME
  LAST FIRST MIDDLE  
PRESENT ADDRESS
  STREET CITY STATE ZIP
PERMANENT ADDRESS
  STREET CITY STATE ZIP
PHONE NUMBER   - - ARE YOU 21 YEARS OR OLDER? YES NO
ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED IN THIS COUNTRY BECAUSE OF VISA OR IMMIGRATION STATUS? YES NO
POSITION: DATE YOU CAN START: SALARY DESIRED:
ARE YOU EMPLOYED NOW? YES NO IF SO MAY WE INQUIRE OF YOUR PRESENT EMPLOYER? YES NO
HAVE YOU EVER APPLIED TO WALDEN/SIERRA BEFORE? YES NO WHEN?
REFERRED BY:
EDUCATION NAME AND LOCATION OF SCHOOL NO OF YEARS ATTENDED SUBJECTS STUDIED
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL
Last Institution Graduated From

GENERAL
SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK
SPECIAL SKILLS

ACTIVITIES: (CIVIC, ATHLETIC, ETC.)
EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREED, SEX, MARITAL STATUS, COLOR OR NATIONAL ORIGIN OF ITS MEMBERS

FORMER EMPLOYERS (LIST BELOW LAST THREE EMPLOYERS, STARTING WITH LAST ONE FIRST)

DATE MONTH/YEAR NAME AND ADDRESS OF EMPLOYER SALARY POSITION REASON FOR LEAVING
FROM:
TO:
FROM:
TO:
FROM:
TO:
FROM:
TO:

 

CRIMINAL BACKGROUND CHECK

I UNDERSTAND THAT IF OFFERED EMPLOYMENT AT WALDEN/SIERRA, INC., AS A CONTINGENCY TO EMPLOYMENT, I MAY BE FINGERPRINTED AND THAT A CRIMINAL BACKGROUND CHECK MAY BE CONDUCTED, AS WELL AS A CHECK OFMY DRIVING RECORD. I FURTHER UNDERSTAND THAT UPON AN OFFER OF EMPLOYMENT, I MAY BE ASKED TO SUBMIT A SWORN AFFADAVID DISCLOSING CRIMINAL CONVICTIONS OR CHARGES PENDING CRIMINAL CHARGES WITHOUT A FINAL DISPOSITION. I HEARBY CONSENT TO SUCH BACK GROUND CHECKS UPON AN OFFER OF EMPLOYMENT FROM WALDEN/SIERRA, INC.

UNDER MARYLAND LAW, AN EMPLOYEE MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.

IN CASE OF EMERGENCY NOTIFY:
- -
NAME ADDRESS PHONE

 

I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME.

 

IN CONSIDERATION OF EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS. I ACKNOWLEDGE THAT THIS APPLICATION FOR EMPLOYMENT IS NOT A CONTRACT. I ACKNOWLEDGE THAT EMPLOYMENT AT WALDEN/SIERRA IS "AT WILL" AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED.