COBYS Employment Application

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis, including race, color, age, sex, religion, or national origin.

List below your last four employers, beginning with the most recent.

Please provide two professional references and one personal reference. References shall be from people who have known you for at least one year. No relatives, please.

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period of time and may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice. I hereby authorize the release to COBYS Family Services of any and all information relative to my employment, including but not limited to dates of employment, attendance records, performance ratings, rates of pay and eligibility for re- employment. I authorize its release without penalty or liability. A photocopy of this authorization shall be considered as valid as the original.