Application for Employment: Pre-Employment Questionnaire, and an Equal Opportunity Employer
** You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied.
List below your last three employers, starting with the most recent one first.
Below, give the names of three work-related references. Only give references you are prepared for MMA to contact.
References for current employer can be provided at a later date. Please only provide direct telephone numbers or extensions.
Do you have any physical limitations that preclude you from performing any work for which you are being considered?
If yes, what can be done to accommodate your limitation?Please describe:
In Case of Emergency:
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that,
if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references listed above to give you any and all
information concerning my previous employment and any pertinent information they may have, personal or otherwise, and
release all parties from all liability for any damage that may result from furnishing same to you.
I understand and agree that, if hired, my employment is provided on an at-will basis for no definite period and may,
regardless of the date of payment of my wages and salary, be terminated at any time without prior notice."