Application for Employment

Date of Application:

 
Position(s) Applied For:

 
Referral Source:
AdvertisementFriendRelativeWalk-InEmployment AgencyOther
 
If Other:

 
Full Name:

 
Street Address:

 
City:

 
State:

 
Zip Code:

 
Phone:

 
Email:

 

APPLICATION DISCLOSURE AND AUTHORIZATION FORM:

I acknowledge and understand that my employment with Cervelli Management, LLC (“Cervelli Management”) is contingent on the verification of my employment history, educational and professional references, and, if applicable, any state, federal and self-regulatory organization (“SRO”) regulatory, registration or licensing agency, board, association or organization. I further understand that Cervelli Management or its agents will obtain a consumer report and/or an investigative consumer report that may contain information about my employment and educational background, criminal history, civil litigation history, credit information, driving record, military service, mode of living, character, general reputation and personal characteristics. I understand that I have the right to obtain additional disclosure as to the nature and scope of the investigation upon written request to Cervelli Management or its agents within reasonable time and to obtain a copy of the report upon request, as well as a written summary of my rights under the Fair Credit Reporting Act.
 
In addition, I understand that Cervelli Management or its agents may periodically check government-sponsored and SRO databases to ensure that I am appropriately registered or licensed, if required, and that I have not been implicated in any improper practices under FINRA, SEC, or any other state, federal or SRO regulatory, registration or licensing agency, board, association or organization; and I understand that Cervelli Management is required by law to verify my eligibility to work in the United States of America.
 
I recognize that this application is not an employment contract, and if employed, I will be an employee-at-will and can be terminated with or without cause or notice at any time at the option of either Cervelli Management or myself.
 
I hereby certify that the information contained in this application is correct and complete to the best of my knowledge.
 
I acknowledge that any omission or misrepresentation of facts called for on this application or during the interview and hiring process will be cause for rejection of this application or termination of employment.
 
I hereby authorize the Cervelli Management or its agents to request all records it deems appropriate to review my application for employment. I further acknowledge and understand that my authorization shall remain on file and continue to serve as an ongoing authorization for Cervelli Management or its agents to request, obtain and use any consumer reports, investigative consumer reports, or any other checks, requests, records or reports described herein, or in any other documents or disclosures provided to me by Cervelli Management’s agents, at any time during my employment.
 
I hereby authorize all companies, associations, organizations, current or former employers, supervisors, credit agencies, educational institutions, law enforcement/criminal justice agencies, city, county, state and federal courts, city, county, state and federal governmental agencies and organizations, SROs, state motor vehicle bureaus, military services and any other entities or persons to release to and furnish to Cervelli Management or its agents any and all information they may have about me. I hereby release each of them and Cervelli Management and its agents from any and all liability for damages of whatever nature that may arise from their furnishing the requested information.
 
AGREE