Employment Application

First name*

Last name*

Phone number*

Email*

What is your highest level of education?*

Are You Currently Employed? *

Previous Employer 1 Name*

Previous Employer #1 Phone Number*

Previous Employer #1 Supervisor Name*

Start Date Previous Employer 1*

End Date Previous Employer 1*If still employed here select today's date

Job Title/Position at Previous Employer #1*

Previous Employer 1 work performed

Employer 1 starting pay rate*

Previous Employer 1 Ending Pay Rate*

Previous Employer 1 Reason for Leaving*

Describe some of the teams you've worked with. What have you liked and disliked about those teams?*

Have you ever worked with a difficult colleague or boss? How did you handle the situation?*

What is the hardest you've ever worked on something in your life?*

What do you like to do when you're not working?*

Would your former coworkers describe you as an empathetic person?*

Additional Reference #1*

Additional Reference #1 phone number*

Additional Reference #2 *

Additional Reference #2 Phone Number*

Can you, after employment, submit verification of your legal right to work in the United states?*

I understand that Dexcomm is a drug free environment with a policy prohibiting the use of illegal drugs. Any initial offer of employment is conditional upon the results of a drug urinalysis test. Additionally, quarterly random screens are conducted to maintain our drug free environment.*

I understand that all the information I have provided in this application is true to the best of my knowledge. Any material falsehood or misrepresentations I provide on this application may be cause for denial of employment or immediate termination. *

In accepting employment with Dexcomm, I understand that Dexcomm is a twenty-four hour, three hundred sixty-five day a year operation. I am aware that I may be required to work varied hours, weekends, holidays, rotating shifts, and that I may be needed to fill on any shift as needed. *

I understand that Dexcomm is an information business, with much of the information being of a confidential nature. I agree to keep confidential any information that I may learn through Dexcomm, whether or not Dexcomm may ever employ me. *

I (now referred to as “applicant”) authorize Dexcomm to conduct a reference check with my present and/or previous employer(s). This also serves to authorize my present and/or previous employer(s) to provide reference information to Dexcomm as it is requested. I understand that reference information may include, but not be limited to, verbal and written inquiries for information about my character, employment performance, professional demeanor and character, rehire potential, dates of employment, salary and employment history. By providing such authorization, I understand and agree that I release Dexcomm, its trustees, management, staff, employees and affiliates, from any and all claims, including potential claims I may have regarding any and all information released to or by Dexcomm and regarding any employment decisions made about me on the basis of such information.*

In the event that the Applicant agrees to accept a position with Dexcomm, the Applicant and Dexcomm agree that the employment relationship between Dexcomm and the Employee is an at will relationship and that the employment relationship and compensation can be terminated, with or without cause, and with or without notice at any time, at the option of either Dexcomm or the Employee.*

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Dexcomm Employment Application