* Required Information

Application for Employment

Position Desired

Dates of employment with New Approach Healthcare,Inc.



Work Experience

Please list all previous employment, beginning with the most recent. If you need more room, you may attach another sheet of paper


Identify three persons who know your work, beginning with the most recent

Authorization and Acknowledgements

I affirm that the information I have provided in this application is true to the best of my knowledge, information and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading information in this application is grounds for discharge.

I authorize the company to verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure.

Employer Notes:

If you are considering obtaining applicant or employee background checks through a third party provider, it is vitally important that you comply with the federal Fair Credit Reporting Act (FCRA). Background checks typically include a variety of information from various sources, including credit reports. The FCRA imposes a number of requirements on employers who obtain and utilize background checks, including a number of very specific notice and disclosure requirements, which are not reflected in this sample employment application.

Please note that your state may also have very specific requirements for conducting background checks. Some states limit or restrict the use of information gained through background checks, including arrest and conviction records as well as credit reports. Employers are strongly advised to consult a knowledgeable employment law attorney before conducting any type of background checks on applicants or current employees.

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