APPLICANT INFORMATION

Address*
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LinkedIn, Indeed, ZipRecruiter, website, etc. If referred by an employee, please give their full name

EMPLOYMENT REFERENCES

May we contact previous employers (other than current) as a reference?*

EDUCATION

MILITARY RECORD

Have you ever served in the US Military?*

ADDITIONAL INFORMATION

If you are hired, are you able to provide proof of eligibility to work in the U.S. within 3 business days of your date of hire?*
Will you now or in the near future require employment sponsorship (i.e. H1B)?*
Are you able to perform the essentials functions of the job for which you are applying, with or without accommodations?*

COMPENSATION EXPECTATIONS

$

PLEASE UPLOAD A CURRENT RESUME

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EEO-1 SELF-IDENTIFICATION FORM

The employer is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, the employer invites employees to voluntarily self-identify their race and ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual. This data is for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment.

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DEMOGRAPHIC QUESTIONS

I identify my gender as (select one)*
Are you Hispanic or Latino? *
Race: Only complete this section if you selected "No, I am not Hispanic or Latino" above. What is your race? (Please select one)*

EQUAL EMPLOYMENT OPPORTUNITY POLICY

It is the policy of BestLife Holdings, Inc., dba Cenegenics, that applicants for employment are recruited, selected and hired on the basis of individual merit and ability with respect to positions being filled
and potential for promotions or transfer which may be exposed to develop. Applicant are to be recruited, selected and hired without regard to race, color, religion, creed, gender, age, national origin, ancestry, disability, veteran status, pregnancy status, sexual orientation or gender identity.  In addition, personnel procedures and practices with regard to training, promotion, transfer, compensation, demotion, lay off or termination are to be administered with due regard to job performance, experience and qualifications, but without regard to race, color, religion, creed, gender, age, national origin, ancestry, disability, veteran status, pregnancy status, sexual orientation or gender identity.


CERTIFICATION AND RELEASE: I certify that all the information in this application is true, complete and correct to the best of my knowledge; and I understand that any material omission, misrepresentation or falsification of this information is grounds for dismissal from or refusal of employment. I hereby authorize investigation of all statements contained in this application, and I authorize my current and former employers to give any information regarding my employment together with all information regarding me, and hereby release from all liability or responsibility all persons, companies, or corporations furnishing such information in good faith. It is my understanding that, if hired, my continued employment would be contingent upon my adhering to the rules, regulations, policies and procedures in effect, and failure to do so can result in my termination without notice. I may terminate my employment with the company at any time, for any reason; and the company for any reason may terminate me, my compensation, and benefits at any time. No employee of the company may change the terms of this agreement.

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DATE*

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