Advanced Acupuncture, Inc.
Programs
Our Clinic
Participating Networks
Professional Training
Employment Openings

Advanced Acupuncture, Inc.
Programs
Our Clinic
Participating Networks
Professional Training
Employment Openings

Advanced Acupuncture, Inc

EMPLOYMENT APPLICATION

We appreciate you sending your resumes via email to advanced_acupuncture@yahoo.com.

PERSONAL INFORMATION

NAME:

Personal Information

Phone Number *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Social Security

Are you 18 Years or Older? *

Yes

No

Email Address *

Employment Desired:

Position

Date you can start:

MM

DD

YYYY

Salary Desired

$

Are you available to work full time:

Yes

No, part-time only

Are you employed now?

Yes

No

If so can we contact your employer?

Yes

No

Have you ever applied to our company before?

Yes

No

If so, When?

Have you ever worked for our company before?

Yes

No

If so, When? Where?

Was termination voluntary or involuntary? Exact reason for leaving?

Name of Supervisor at your company?

Who referred you to our company?

Former Employers

Name of present or last employer:

First Name

Last Name

Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Starting Date:

MM

DD

YYYY

Ending Date:

MM

DD

YYYY

Hr/Mo starting Salary:

$

Hr/Mo Final Salary:

$

Job Title

May we contact your immediate supervisor?

Yes

No

Name of immediate supervisor:

First Name

Last Name

Title of immediate supervisor:

Description of work

Was termination voluntary or involuntary? Exact reason for leaving?

2. Name of former employer:

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Starting date:

MM

DD

YYYY

Ending date:

MM

DD

YYYY

Hr/Mo Starting Salary:

$

Hr/Mo Ending Salary:

$

Job Title

May we contact immediate supervisor:

Yes

No

Name of immediate supervisor:

First Name

Last Name

Title of immediate supervisor:

Description of work

Was termination voluntary or involuntary? Exact reaosn for leaving:

3. Name of former employer:

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Starting date:

MM

DD

YYYY

Ending Date:

MM

DD

YYYY

Hr/Mo Starting Salary

$

Hr/Mo Final Salary

$

Job Title:

May we contact your immediate supervisor?

Yes

No

Name of immediate supervisor:

First Name

Last Name

Title of immediate supervisor:

Description of work

Was termination voluntary or involuntary? Exact reason for leaving?

4. Name of former employer:

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Starting date:

MM

DD

YYYY

Ending date:

MM

DD

YYYY

Hr/Mo Starting Salry:

$

Hr/Mo Ending Salary:

$

Job Title:

May we contact your immediate supervisor:

Yes

No

Name of immediate supervisor:

First Name

Last Name

Title of immediate supervisor:

Description of work

Was termination voluntary or involuntary? Exact reason for leaving:

EDUCATION:

Name of school:

Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Years attended:

Did you Graduate?

Elementary School:

High School:

College:

Trade, Business or Correspondence School:

REFERENCES

Please give the names of three persons not related to you, whom you have known for at least one year:

1. Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number: *

Business:

Years Aquainted:

2. Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number: *

Business:

Years Aquainted:

3. Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number:

Business:

Years Aquainted:

MISCELLANEOUS:

Subject of special or research work:

Special Training:

Special Skills:

Do you have any commitments to another entity, business or person that might affect your employment with our company:

Yes

No

Explain fully:

I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRITING AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING. I HAVE READ THE FOLLOWING STATEMENT: *

Yes

No

Thank you for your application. We will contact to you shortly

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Office
622 W Duarte Rd, Ste 204
Arcadia, CA 91007

advanced_acupuncture@yahoo.com
(626) 462-9821

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