References
Applicant's Statement
Application - Servant HR 3 of 3
9/16
_____________________________________________________ ____________________
Signature of Applicant Date
Email Address Phone Number Years Known
_____________________________________________________________________________________________________
Name Email Address Phone Number
Years Known
_____________________________________________________________________________________________________
Name Email Address Phone Number Years Known
_____________________________________________________________________________________________________
Name Email Address Phone Number Years Known
Email Address Phone Number Years Known
I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be
necessary in arriving at an employment decision. In addition, I authorize a complete background
check, including a credit check, a criminal history check, driver’s record check, drug screen, and
reference checks.
This application for employment shall be considered active for a period of time not to exceed 45
days. Any applicant wishing to be considered for employment beyond this time period should
inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any
employment relationship with Servant HR (“Employer”) is of an "at will" nature, which means that
the Employee may resign at any time and the Employer may discharge Employee at any time with
or without cause. It is further understood that this "at will" employment relationship may not be
changed by any written document or by conduct unless such change is specifically acknowledged
in writing by an authorized executive of Servant HR.
In the event of employment, I understand that false or misleading information given in my
application or interview(s) may result in discharge. I understand, also, that I am required to abide
by all rules and regulations of the “Employer.”
