Application
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Application
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Application
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Please answer all questions. If a question does not apply to you, answer with "No" or "NA" for "Not Applicable."

*Denotes required field.

TODAY'S DATE: 05/10/21

Personal Information
  • Receiving Coordinator Day Shift
  • YESNO
  • YESNO
  • YESNO
  • YESNO
  • NIGHTSWEEKENDS
  • YESNO
Education
  • 6 7 8
  • YES NO
  • 9 10 11 12 GED
  • YES NO
  • 13 14 15 16
  • YES NO
  • YES NO

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Application
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Application
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Application
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Employment Record

List your last three employers. Complete all information. List your most recent job first. To add another employer, click the ADD ANOTHER button below.

  • YESNO
Military Service

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Application
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Personal References

List at least three persons to whom you are not related and by whom you have not been employed. Ideally, these persons should have known you for several years.

  • I certify that the information contained in this application is correct to the best of my knowledge and understand that falsification of this information is grounds for refusal to hire or if hired, dismissal. I hereby authorize and request any former employer, treating physician or hospital, or any other persons or companies including any city, county, state or federal agency, department or bureau to furnish to iWC, or its authorized representatives any information in their files under my name. I agree to hold any source of information harmless for any error in reporting this information and release all persons whomsoever from any damages on account of furnishing said information. A photocopy of this authorization may be accepted by anyone as though it were the original.

  • If I am hired by iWC, I agree to conform to the rules and regulations of the company and acknowledge that the rules and regulations may be changed, interpreted, withdrawn, or added to by the company at any time, at the company’s sole option and without any prior notice to me. I further acknowledge that my employment is “at will” and may be terminated, and any offer of employment or my acceptance of an employment offer, may be withdrawn at any time, at the option of the company or myself. I understand that no representative of the company has any authority to enter into any agreement for employment for any specified period of time or to assure any other personnel action, either prior to commencement of employment or after I have become employed, or to assure any benefits or terms and conditions of employment, or make any agreement contrary to the foregoing. I acknowledge that I have been advised that this application will remain active for the period specified by federal or state law.

  • Further, I agree to submit to a physical examination including a drug screen test by a physician designated by the company if either or both are required as a condition of employment or continued employment. I understand IWC is a member of the Tennessee Drugfree Workplace Program.

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