Application for Employment at Medlin-Davis

Personal Information

Are you 18 Yours or Older?

Desired Employment

Are you employed now? Yes No
If so may we inquire of your present employer? Yes No
Ever applied to Medlin-Davis before? Yes No

Ever worked for Medlin-Davis before? Yes No

Who referred you to Medlin-Davis?
Employment Agency
Newspaper Advertising
State Employment Office
College Placement Service
Walk In



Former Employers

List below last three employers, starting with the most recent.

May we contact your supervisor? Yes No

May we contact your supervisor? Yes No

May we contact your supervisor? Yes No


Below, give the names of three persons you are not related to, whom you have known at least one year.

Service Record

Have you been convicted of a felony within the last 5 years? Yes No


"I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release Medlin-Davis from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of Medlin-Davis has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized Medlin-Davis representative."

By clicking "Submit" below, you agree to submit an application for employment to Medlin-Davis... You further agree that Medlin-Davis may investigate the application, and that any person, reference or former employer named in this application may be contacted by Medlin-Davis. All persons, firms or corporations named as references or former employers are released to provide employment information, including payroll and salary information to Medlin-Davis unless otherwise noted.

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