support@myterrio.com

(661) 377-1700

PERSONAL INFORMATION
ARE YOU LESS THAN 18 YEARS OF AGE
UPON OFFER OF EMPLOYMENT, VERIFICATION OF YOUR LEGAL RIGHT TO WORK IN THE UNITED STATES WILL BE REQUIRED
EMPLOYMENT DESIRED
HAVE YOU EVER BEEN EMPLOYED BY OUR ORGANIZATION BEFORE?
IF YES, GIVE DATES OF EMPLOYMENT
IF YES, GIVE DATE/POSITION APPLIED FOR
ARE YOU ABLE TO PERFORM THE ESSENTIAL FUNCTIONS OF THE JOB FOR WHICH YOU ARE APPLYING WITH OR WITHOUT REASONABLE ACCOMMODATION?
CAN YOU WORK OVERTIME?
ARE YOU CURRENTLY EMPLOYED?
IF SO, MAY WE CONTACT YOUR PRESENT EMPLOYER?
EDUCATION/U.S. MILITARY SERVICE
SCHOOL LEVEL SCHOOL
NAME & LOCATION OF
HIGH SCHOOL
COLLEGE
COLLEGE
OTHER
PROFESSIONAL CERTIFICATES OR LICENSES HELD
HAVE YOU EVER SERVICED IN THE U.S. ARMED SERVICES:
PLEASE INDICATE ANY LANGUAGES, OTHER THAN ENGLISH THAT YOU
MAJOR
UNITS COMPLETED AND GRADE AVERAGE
DEGREES AND/OR DIPLOMAS
ARE YOU PRESENTLY TAKING ANY EDUCATIONAL COURSE? IF YES, MILITARY DUTIES AND TRAINING
IF YES, MILITARY DUTIES AND TRAINING
PLEASE LIST JOB RELATED ORGANIZATIONS, CLUBS, PROFESSIONAL SOCIETIES, OR OTHER ASSOCIATIONS TO WHICH YOU BELONG – YOU MAY OMIT THOSE WHICH INDICATE YOUR RACE, RELIGIOUS CREED, COLOR, NATIONAL ORIGIN, ANCESTRY, SEX OR AGE
REFERENCES
PLEASE LIST THREE NON-RELATIVES WHO ARE QUALIFIED TO EVALUATE YOUR

CAPABILITIES

NAME AND ADDRESS
TELEPHONE
OCCUPATION
YEARS KNOWN
EMERGENCY INFORMATION
IN CASE OF EMERGENCY, NOTIFY
NAME
TELEPHONE NUMBER
ADDRESS
CITY
STATE
ZIP
EMPLOYMENT HISTORY

GIVE EMPLOYMENT RECORD AS COMPLETELY AS POSSIBLE, LISTING MOST RECENT EMPLOYMENT FIRST, INCLUDE EMPLOYED/SELF-EMPLOYED PERIODS AND PART-TIME OR SUMMER WORK

COMPANY NAME & LOCATION
1.
TELEPHONE
POSITION(S) HELD
DATES EMPLOYED
REASON FOR LEAVING
DESCRIPTION OF DUTIES
TYPE OF Business
COMPANY NAME & LOCATION
2.
TELEPHONE NUMBER
POSITION(S) HELD
DATES EMPLOYED
REASON FOR LEAVING
DESCRIPTION OF DUTIES
TYPE OF Business
COMPANY NAME & LOCATION
3.
TELEPHONE NUMBER
POSITION(S) HELD
DATES EMPLOYED
REASON FOR LEAVING
DESCRIPTION OF DUTIES
TYPE OF Business
COMPANY NAME & LOCATION
4.
TELEPHONE NUMBER
POSITION(S) HELD
DATES EMPLOYED
REASON FOR LEAVING
DESCRIPTION OF DUTIES
TYPE OF Business
MAY WE CONTACT THESE EMPLOYERS:
ACKNOWLEDGMENT
  1. Any acceptance of employment will be predicated upon the truthfulness of the written and verbal statements contained within this application and preceding employment process. I understand that should my employer find that any statement I have made is not truthful, any job extended to me may be withdrawn and, if employed, I may be subject to termination.
  2. I understand this Application of Employment is not to be confused as a guarantee of employment for a specific time. I further understand that my employment with Terrio Therapy-Fitness, Inc. does not constitute any form of contract, implied or expressed, and such employment will be terminable as at will either by myself or my employer upon notice of one party to the other. My continued employment is dependent on satisfactory performance and the continued need for my services as determined by this organization.
  3. I grant my employer approval, after my termination of employment to release information which it may deem appropriate regarding my employment with or termination from the organization, to anyone who has a reasonable basis for making such inquiry. So long as the information disclosed is not known by this organization to be inaccurate, this organization shall not incur legal liability of any nature in connection with the furnishing of such information.
  4. If a conditional offer of employment is made, I consent to a health assessment. If it is determined during the health assessment that I have a medical condition that prohibits me from performing the essential job functions, I must obtain a medical release from my physician. If the release clears me to perform the essential job functions either with or without reasonable accommodations, the employment process will continue. If the release does not clear me to perform the essential job functions, Terrio Therapy Fitness will release me from this job offer. I understand that if I am released from this job offer, I have the option to begin the application process again for other available positions in which I am able to perform the essential job functions with or without reasonable accommodations
  5. I acknowledge that I have read all of the above statements and that I understand them.