Personal Information

Please answer all of the following questions.

Previous Employment

Previous Employer (2)

Previous Employer (3)

Previous Employer (4)

Education Level

High School

College

Graduate School

Please List Any Professional, Educational or Civic Organization Memberships

Please List Any Additional Qualifications or Information

Professional References

Professional References

Professional References

Applicant's Certification Agreement

1. The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex or national origin. Federal law also prohibits other types of discrimination such as age, citizenship, disability, veteran status, attainment of benefits, and participation in union activities. The laws of most states and many localities also prohibit some or all of the above types of discrimination as well as some additional types including, but not limited to, discrimination based upon ancestry, marital status, parental status, sexual orientation, or source of income. The Fair Credit Reporting Act imposes restrictions with respect to information obtained from a consumer reporting agency, including but not limited to information regarding credit data, personal character, general reputation, and mode of living. This list, however, is not exhaustive of the grounds on which discrimination is prohibited.
2. By my signature below, I promise that the information provided in this employment application (and accompanying resume or documentation, if any) is true and complete, and I understand that any false or misleading information or significant omissions may disqualify me from further consideration for employment, and may lead to my dismissal from employment, if discovered at a later date. I agree to notify Willow Brook if I should be convicted of a felony, or any crime involving dishonesty, theft, breach of trust, controlled substances, sexual misconduct, abuse, or violence, while my job is pending, or during my period of employment if hired.
3. I authorize any person, school, current employer, past employer(s), organizations named in this application (and accompanying resume, if any) and federal, state, county, and local agencies to provide Willow Brook with any information and opinions requested by Willow Brook in connection with any application, and I release such persons and organizations and Willow Brook, and their representatives, from any legal liability in making such statements.
4. I understand that this application does not create a contract of employment. I understand that, if hired, I am obliged to comply with any and all current and subsequently adopted Willow Brook policies. I understand and agree that, if hired, my employment is for no definite period of time, and may, regardless of the date of payment of my wages or salary, be terminated at any time for any reason, with or without notice.
5. As part of my application for employment, I may be asked to sign a release of information authorization. This is to allow Willow Brook to verify my references and, in Willow Brook's discretion, to perform other background investigations to determine my qualification for employment. Through a separate agency, Willow Brook may choose to investigate my academic credentials, prior employment, personal/professional references, credit record, motor vehicle record, and/or criminal record. I will be provided with a separate authorization and release form for this purpose.