Email Address

Position Applied for

If yes, when?

If yes, explain

Education

We require official transcripts for the highest level of education completed

High School

Degree

Special Training and Skills

Describe any speclalized training approntlocship, skils and extra-curricular activitles that you have or are Involved nI that would relate to the position for which you are applying:

Describe any Academic Honors or Professional Honors you have received:

State any additional information you feel may be helpful to us in considering your application

Indicate any foreign languages you can speak, read and/or write fluently

References

Please list three professional references.

Relationship

Company

Relationship

Company

Relationship

Company

Previous Employment

Company

Supervisor

Job Title

Starting Salary

$

Ending Salary

$

Responsibilities

Reason for Leaving

Company

Supervisor

Job Title

Starting Salary

$

Ending Salary

$

Responsibilities

Reason for Leaving

Company

Supervisor

Job Title

Starting Salary

$

Ending Salary

$

Responsibilities

Reason for Leaving

Military Service

Branch

Rank at Discharge

Type of Discharge

If other than honorable, explain

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. I authorize investigation of al statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of lime not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby acknowledge that any employment relationship with ECCH is of an "at will" nature, which means that the employer may discharge the employee at any time with or without cause. It is further understood this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledge in writing by an authorized executive of ECCH. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my discharge. I understand also, that I am required to abide by all rules and regulations of ECCH. I understand if the job for which I am applying requires a valid NC Driver's License and Social Security Card, that I will provide the organization with a copy of these items upon interview with the organization.

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