Thompson's Residential Treatment Center

Personal Information
Name
First Middle Last
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email Address*
Phone Number*
Are you 21 years or older?
- Yes
- No
Date you can begin working if hired?
MM slash DD slash YYYY

Special Questions
Name of any relatives currently employed with Thompson's RTC
If you have been referred by someone, please list their name.
Are you either a U.S. citizen or an alien authorized to work in the United States?
- Yes
- No
Have you been arrested or convicted of a felony or misdemeanor at any time?
- Yes
- No
If yes, please describe.
I understand and agree that I may be required to take either a physical examination or an examination for the use of controlled substances. I agree to consent to take such test(s) at such time as designated by the company and to release the company, it's directors, officers, agents or employees from any claims arising in connection with the use of such test(s).
- Yes
- No
I understand the Age Discrimination in Employment Act of 1967prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age.
- Yes
I understand that I will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied.
- Yes
If you require special accommodations to work, please explain below.

Education and Experience
If your resume is available, please upload it. If not you can provide the information below.
Do you have a resume available to upload?
- Yes
- No
If you have a resume, please upload it here.
Max. file size: 32 MB.
Employer
Dates of Employment Name of Employer Address of Employer Position Salary Reason for Leaving
School
This can include trade schools, college, highschool, GED, ect.
Name of School Location of School Number of years Attended Year Graduated Subjects Studied
Please list any general certifications, licenses, and registrations you have earned.
References
Please provide at least 2 persons not related to you, whom have known you for at least 1 year.
Name Phone Number Business Years Acquainted

Authorization and Signature
I certify that the facts contained in this application are true and completed to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal.
- Yes
I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.
- Yes
I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice.
- Yes
Signature
Date
MM slash DD slash YYYY

Employment Application

Dates of Employment	Name of Employer	Address of Employer	Position	Salary	Reason for Leaving

Name of School	Location of School	Number of years Attended	Year Graduated	Subjects Studied

Name	Phone Number	Business	Years Acquainted