Pennsylvania Specialty Pathology

Order Test

Employment Application

"*" indicates required fields

Applicant Information

Name*
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Address*
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Are you a citizen of the United States?*
If no, are you authorized to work in the U.S.?
Have you ever worked for this company?*
Have you ever been convicted of a felony?*
NOTE: An affirmative answer will not necessarily result in disqualification for employment.

Education

Did you graduate?
Did you graduate?
Did you graduate?

References

Please list three professional references.
Full Name
Relationship
Company
Phone
Address
 

Previous Employment

Address
Name of Immediate Supervisor
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MM slash DD slash YYYY
May we contact your previous supervisor for a reference?

 

Address
Name of Immediate Supervisor
MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact your previous supervisor for a reference?

 

Address*
Name of Immediate Supervisor
MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact your previous supervisor for a reference?*

Military Service

MM slash DD slash YYYY
MM slash DD slash YYYY

Disclaimer and Signature

The information that I have provided on this application is accurate to the best of my knowledge and may be verified by Pennsylvania Specialty Pathology or its agents.
I understand that Pennsylvania Specialty Pathology is committed to maintaining a drug and alcohol free work place. Accordingly, I may be subject to a pre-employment blood test, urinalysis or other drug/alcohol screening. I further understand that if employed, I may be subject to such a drug and alcohol screening if Pennsylvania Specialty Pathology has reasonable suspicion to believe that I am under the influence of a drug or alcohol. My consent to submit to such a test is required as a condition of employment and my refusal to consent shall result in a refusal to hire or, if already employed, termination.
I understand that Pennsylvania Specialty Pathology is committed to maintaining a drug and alcohol free work place. Accordingly, I may be subject to a pre-employment blood test, urinalysis or other drug/alcohol screening. I further understand that if employed, I may be subject to such a drug and alcohol screening if Pennsylvania Specialty Pathology has reasonable suspicion to believe that I am under the influence of a drug or alcohol. My consent to submit to such a test is required as a condition of employment and my refusal to consent shall result in a refusal to hire or, if already employed, termination.
I authorize Pennsylvania Specialty Pathology to obtain criminal background checks for use in deciding whether or not to offer me employment.
I understand and agree that any misrepresentation or omission of facts in this application will be justification for refusal or termination of employment, regardless of the time elapsed before discovery.
I understand and agree that the employment for which I am making application is at-will and such employment may be terminated at any time with or without case and/or without prior notice. There will be no agreement, express or implied between Pennsylvania Specialty Pathology and me for any specific period of employment, nor for continuing or long term employment, unless made in writing, signed by an authorized representative of Pennsylvania Specialty Pathology.
I have placed my signature in the space provided below only after I have completed the entire to the best of my ability and have carefully read the foregoing seven (7) statements.
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.

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