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About MPH
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Employment
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Applicant Information
Full Name:
Date:
MM slash DD slash YYYY
Last Name
First Name
Middle
Address:
Street Address
Apartment/Unit #
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone:
Email:
Date Available:
MM slash DD slash YYYY
Desired Salary
Position Applied for:
Are you authorized to work in the U.S.?
Yes
No
Have you ever worked for this company?
Yes
No
If yes, when?
Have you ever been convicted of a felony?
Yes
No
If yes, explain?
Education
High School:
Address:
Did you graduate?
Yes
No
College:
Address:
Did you graduate?
Yes
No
Degree:
Other:
Address:
Did you graduate?
Yes
No
Did you graduate?
Yes
No
Degree:
References
Please list three professional references.
Full Name:
Relationship:
Company:
Phone:
Address:
Full Name:
Relationship:
Company:
Phone:
Address:
Full Name:
Relationship:
Company:
Phone:
Address:
Previous Employment
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Reason for Leaving
May we contact your previous supervisor for a reference?
Yes
No
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Reason for Leaving
May we contact your previous supervisor for a reference?
Yes
No
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Reason for Leaving
May we contact your previous supervisor for a reference?
Yes
No
Military Service
Branch:
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Rank at Discharge:
READ CAREFULLY AND SIGN BELOW IF YOU AGREE TO THESE TERMS OF EMPLOYMENT
I, the undersigned applicant for employment, understand and agree that all employment at MPH (the “Company”) is on an at-will basis, and may be terminated by the employee or the Company at any time for any cause or no cause. I understand and agree that no one employed by the Company (except the Company’s President) has any authority to offer employment other than on an at-will basis.
I certify that the facts contained in this application are true and complete and that any falsification, misrepresentation or omission herein may result in refusal of, or immediately termination from employment. I authorize and request my former employers, references and educational institutions to give the Company any and all information and opinions about me in their possession; I hereby waive written notice of such release of information and opinions and I release my former employers, references and educational institutions from any liability or claim relating to such release of information and opinions. I also authorize and request federal, state and local governmental agencies to release to the Company any information requested concerning any criminal convictions on my record.
I agree that the contents of any Company property I may be using, and of my own property I bring onto the Company’s premises (including without limitation cars, packages, and purses) may be inspected by the Company at any time, and I waive and promise not to make any claims against the Company (or its employees, owners, or agents) relating to such inspection.
I agree to submit to physical examinations permitted by law performed by a health care professional before and during my employment at the request and expense of the Company, and I agree to disclose completely all information lawfully requested at such examinations about my physical condition and medical history. I also agree that before and during my employment, at the request and expense of the Company, I will cooperate in such lawful medical tests (including blood, urine, or other testing) as the Company requests to check for drugs or alcohol in my system, or for any other physical condition. I waive and release and promise not to make any claims against the Company (or any testing agency retained by it, or their employees, owners and agents) related to any such testing, or from lawful decisions made regarding my employment or termination of employment based upon the results of such testing or analysis.
I agree that, except as prohibited by statute, the Company may disclose any information or opinions relating to me or my employment to employees of the Company or third parties, and I waive and release and promise not to make any claims against the Company (or its employees, owners, or agents) relating to any such disclosure.
I agree that, except as directed otherwise by the Company, I will not disclose to anyone or use for my own purposes, any of the Company’s confidential or proprietary information, either during or after my employment. I understand and agree that the Company’s trade secrets, bidding, costs, pricing and marketing information and techniques, financial and market information, computer software, sources of supply and customer names and information are confidential and proprietary information of the Company; I also agree that I will not make written or other copies of notes regarding these matters except as necessary to perform my job, and I agree that if my employment with the Company ends, I will deliver to the Company all materials of any kind that I have relating to the Company, including any such copies or notes. I also agree that I will disclose and assign to the Company any invention, design or process relating to the Company’s business which I develop or conceive while with the Company and that all such designs or conceptions shall be the property of the Company.
I agree that I will not commence any action or suit relating to my employment with the Company (or termination of the employment) more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit, and I agree to waive any statute of limitations to the contrary. I understand that this means that, even if the law would give me the right to wait a longer time to make a claim, I am waiving that right, and that any claims not brought within six (6) months after the date of the employment action at issue are waived.
I agree to the above terms of employment. I agree that if any of the above commitments by me is ever found to be legally unenforceable as written, the particular agreement concerned shall be limited to allow its enforcement as far as legally possible and shall not affect the rest of this agreement. I understand and agree that no one other than the President of the Company, by a written resolution authorizing a contract with a specific named individual, has any authority to modify or announce modification of the above terms of employment and policies, or to make any exception to them, or to offer employment on any other terms. I understand and agree that, except as provided above, all benefits, programs, rules and policies of the Company are subject to exceptions or change at will at any time as decided by the Company.
Date:
MM slash DD slash YYYY
Signature of Applicant
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