* Current Department:

* Current Location:

* Current Job Title:

* Time in Present Position:

* Hire Date:

* Supervisor's Name:

* Have you notified your immediate supervisor of your interest in this position? (Notification is required prior to being considered.):

Yes   No

If no, please explain:

* Are you currently under a corrective disciplinary action or performance improvement plan? (Favorable performance is required prior to being considered).:

Yes   No

If yes, please explain:

Please provide details as to why this position would be a good fit for your qualifications.:

After starting with Ridgeview, if you have completed any additional education, please provide details - any additional High Schools, Colleges, Universities and Vocational/Technical Schools. you have attended.

School Name & Location	Did you Graduate?	Degree Received	Subjects Studied/Major
	Yes   No
	Yes   No
	Yes   No

“I certify that the information given by me in this application is true in all respects, and I agree that if the information given is found to be false in any way, it shall be considered sufficient cause for denial of employment or discharge. I authorize the use of any information in this application to verify my statements, and I authorize past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information.”

“I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between Ridgeview and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Ridgeview unless made in writing. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and that Ridgeview retains the same right.”

“If I am offered employment, I agree to submit to a physical examination whenever requested, and I understand my becoming employed and/or my continued employment are subject to the results of any physical examination related to my job duties in accordance with Ridgeview policies and procedures.”

“I understand that if employed, policies, and rules which are issued are not conditions of employment and that Ridgeview may revise policies or procedures in whole or in part, at any time.”

“I understand that this application will be kept on active file for 90 days from the date completed, after which time I would have to reapply in accordance with established Ridgeview procedures.”

* Signature (type name):

* Date: