Job Application Form

Wallingford Eye Care Center

Application for Employment
Please complete the form below to apply for a position with us.

Wallingford Eye Care Center does not discriminate in any employment practice on the basis of race, religion, sex, age, gender, marital status, national origin, veteran’s status, or disability. No question on this application is intended to secure information that could be of a discriminatory nature.

Wallingford Eye Care is always accepting applications for employment.

Our office may or may not be hiring at the time this form is completed.

Your information may be held until a position opens up.
Today's Date

Month Day Year
Full Name *

First Name Middle Name Last Name Suffix
Current Address

Street Address

Street Address Line 2

City State

Zip Code
Email Address *
Phone Number

Area Code Phone Number
Are you currently employed?
May we contact your current employer?
Have you been employed by Wallingford Eye Care before?
Are you eligible to work in the United States?
Are you available to work evenings and weekends? *
Are you interested in a full time or part time position? *
Applying for Position *
Available to begin work

Month Day Year
Salary Requested *
per hour
Cover Letter *
Upload Resume
Applicants will not be contacted if there is no resume on file with our office. If you have already submitted a resume (through indeed or zip recruiter), you do not need to do so again.
Upload References
References are required; please upload them here or include the contact information below.
Professional Reference #1

First Name Last Name
Phone Number

Area Code Phone Number
Relationship
Professional Reference #2

First Name Last Name
Phone Number

Area Code Phone Number
Relationship
Personal Reference

First Name Last Name
Phone Number

Area Code Phone Number
Relationship
PLEASE READ CAREFULLY BEFORE SIGNING THIS APPLICATION
I understand that consideration of this application in no way implies a contract of employment. I understand that if an employment relationship is established, I have the right to terminate my employment at any time for any reason. At any time during the first ninety (90) days of my employment, my position may be terminated with compensation paid through the last day worked.

I understand that Wallingford Eye Care Center promotes a drug/alcohol free workplace and agree to abide by the guidelines established in the Policy and Procedure Manual.

I certify that the answers given in this application are true and accurate to the best of my knowledge. I understand that any false information, misleading statements, or omission of facts is sufficient cause for rejection of my application if Wallingford Eye Care Center has not employed me and immediate termination if Wallingford Eye Care Center has employed me.

In the event of my employment with Wallingford Eye Care Center I will comply with all rules, regulations, and policies set forth in the Policy and Procedure Manual or other policies communicated to me.

I hereby acknowledge that I have read and understand the preceding statements.
Signature *

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Wallingford Eye Care Center