Seeking Employment


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Seeking Employment
From time to time, Dr. Fragola reviews applications for employment in his work force family. Please feel free to complete and submit or fax an application to us at your lesiure.

First Name *
 Last Name *
Street Address
City
 State
 		Zip Code
E-mail Address *
Position Applying For:
Have you ever applied with Dr. Fragola before?
Yes    No   
Are you legally authorized to work in the United States?
Yes    No   
Hourly wage desired:
If yes, please list position applied for:
Approximate date of last application:
Languages you speak other than English

 

 

 Type of postition applying for:
Full Time   
Part Time   
Temp   
Date you are available for work
Number of hours available per week
Have you been convicted of a felony in the last 7 years
Yes   
No   
If Yes please explain:

 

 

Education

Please complete this section as it pertains to position
High School
 Graduated?
Yes    No   
College
 Graduated?
Yes    No   
Vocational
 Graduated?
Yes    No   
Other
 Graduated?
Yes    No   

 

 

 

Employment History

                                                      

Employer Name
 Employment starting
 Employment Ending
Employer's Address
 City
 State
 Zip Code
Employer's Telephone number
 Your position/title
 Supervisor's name
Description of your job responsiblities
Reason for leaving
Employer Name
 Employment starting
 Employment Ending
Employer's Address
 City
 State
 Zip Code
Employer's Telephone number
 Your position/title
 Supervisor's name
Description of your job responsiblities
Reason for leaving
Employer Name
 Employment starting
 Employment Ending
Employer's Address
 City
 State
 Zip Code
Employer's Telephone number
 Your position/title
 Supervisor's name
Description of your job responsiblities
Reason for leaving
Employer Name
 Employment starting
 Employment Ending
Employer's Address
 City
 State
 Zip Code
Employer's Telephone number
 Your position/title
 Supervisor's name
Description of your job responsiblities
Reason for leaving
STATEMENT OF DISCLOSURE: I hereby declare that all statements contained in this application are true and correct and I understand that false, inaccurate, or incomplete information, or omissions on the application will be basis for rejection, or may be cause for subsequent termination if I am hired. I hereby authorize Dr. Fragola to investigate my background and verify this information. I understand that, if employed, my employment will not be for any fixed period of time and may be terminated by Dr. Fragola at any time. I also understand that my failure to report to work will indicate that I have quit.
REFERENCE RELEASE FORM: I voluntarily and knowingly authorize any former employer, person, firm corporation, school or government agency, its officers, employees and/or agents to release any and all information concerning my former employment, education, and/or background information to Dr. Fragola , his officers, employees, and/or agents, making a written or oral request for such information. I understand that the information may include, but is not limited to, performance evaluation and sports, job descriptions, disciplinary reports, letters of reprimand, grades, and opinions regarding my suitability for employment possessed by it. I recognize that a copy of this authorization and release is as valid as the original and should be considered as such. I voluntarily and knowingly, fully release and discharge, absolve, indemnify and hold harmless such former employer, person, firm, corporation, school or government agency, its officers, employees and agents from any and all claims, liability, demands, causes of action, damages, or costs including attorney's fees, present or future, whether known or unknown, anticipated or unanticipated, arising from the disclosure or release; except for the malicious and willful disclosure of derogatory facts which the officer, employee, or agent disclosing such facts knows are untrue.
Authorization for form release *
I agree to these terms.   
I do not agree to these terms.   
Contact Phone
 How do you wish to be contacted?
How did you hear about us?
Yellow Pages    Internet   
Newspaper    Other   
Comments
You may also print out and fax this form to (631) 422-6372
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* Required to submit this form



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Anthony C. Fragola, D.D.S., and Associates
(631) 422-6312

Home  |  About Dr. Fragola  |  Directions  |  Links  |  Health History  |  Why Laser? RCT Ans.  |  Referring Doctors  |  Thank You Letters  |  Seeking Employment  |  Why Laser?






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