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  • THE FOLLOWING INFORMATION WILL ONLY BE CONSIDERED IF IT IS RELEVANT TO THE POSITION FOR WHICH YOU ARE APPLYING OR COULD BEAR UPON STATE LICENSING REQUIREMENTS


  • The following information will be used only to the extent that is relevant to the qualifications and positions for which you apply.


  • List all employment, including military, for the past seven (7) years beginning with your present job or last job held. If you need additional space, continue on a plain sheet of paper and attach it to the application.

    ***This portion must be filled out regardless if a resume accompanies the application.***


  • Employment History 1

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  • Employment History 2

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  • Employment History 3

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  • Employment History 4

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  • Employment History 5

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  • REFERENCES: Please provide the names of four people who are not related to you and who are former employers or co-workers. (Please list day-time contact information for these references.)


  • Reference 1


  • Reference 2


  • Reference 3


  • Reference 4


  • UNDERSTANDINGS AND AGREEMENTS

    I understand that any misrepresentation, falsification, or omission of this application shall be sufficient reason for refusal or dismissal of my employment. I hereby authorize investigation of all matters contained in this application and agree that if the results of such investigation are not satisfactory, any offer of employment made by Quantum Health Professionals or any subsidiary hereinafter referred to as Quantum may be withdrawn, or my employment with Quantum may be terminated immediately. I agree to conform and adhere to the rules regulations of Quantum. Further, I understand and agree that this application and any other materials I may receive are not intended to be, nor shall be construed to be a contract of employment, and that my employment and compensation may terminate, with or without cause, and with or without notice, at any time, at the option of Quantum or myself.

    In consideration of any offer of employment by Quantum, I hereby acknowledge, understand and agree that the following will constitute terms and conditions of any such employment:

    Any losses or expenses incurred by Quantum, its clientele, or other third parties as a result of my unauthorized actions shall be immediately reimbursed to Quantum on terms that are satisfactory and acceptable to Quantum. To the extent permitted by the law, I agree and hereby authorize Quantum to reduce wages for any sums owed by me hereunder.

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