Application for Employment

  • EQUAL OPPORTUNITY EMPLOYER. It is our policy to abide by all federal, state and local laws prohibiting employment discrimination based on a person's race, color, religious creed, sex, national origin, ancestry, citizenship status, pregnancy, childbirth, physical disability, mental and/or intellectual disability, age, military status, veteran status (including protected veterans), marital status, registered domestic partner or civil union status, familial status, gender (including sex stereotyping and gender identity or expression), medical condition (including, but not limited to, cancer related or HIV/AIDS related), genetic information, sexual orientation, or any other protected status.
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  • Education & Training

  • High School

  • College

  • Graduate School

  • Trade School

  • * Only list colleges or universities accredited by the Department of Education (DOE). The DOE maintains a database of accredited institutions at It is your responsibility to verify accreditation.
  • List coursework undertaken or degree/diploma received from an unaccredited college, as well as any other education, training, special skills or certificates/licenses that you possess related to the job.
  • If Yes, give dates:
  • Employment History

    (List all work experience beginning with the present or most recent job. The Miller Group will contact all previous employers to verify your employment. Please list your current or most recent employer first and indicate whether your are currently employed in the spaces provided. The Miller Group will not contact your current employer without permission. You may also include any volunteer and/or military work.)
  • Current/Most Recent Job

  • Previous Employment

  • Previous Employment

  • Business References

    (List three individuals, in addition to listed employment references, known to you for at least three years)
  • Additional Information

  • Agreement (Please read the following statement carefully)

  • I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsification or significant omission of information requested in this application or in the application process may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.

    I authorize all persons listed above (and on the accompanying resume, if any) to give The Miller Group any and all information concerning my previous employment and education and any pertinent information they may have, personal or otherwise, and release all parties, such persons and The Miller Group, from liability for any damage that may result from furnishing same to The Miller Group.

    If employed by The Miller Group and its client company I agree to abide by the policies and procedures of The Miller Group and its client company, which include the The Miller Group Anti-Harassment Policy. I further understand that my employment can be terminated, with or without cause or notice, at any time, at the discretion of The Miller Group, the client company or myself. I further understand that no manager or representative of The Miller Group or its client company other than the president of The Miller Group has any authority to enter into any agreement, oral or written, on behalf of The Miller Group for a term of employment or to make any assurance or promise of continued employment.

    DRUG TESTING: I understand and agree that, subject to applicable law, I may be required to take a drug and alcohol screening test. I also understand that if I test positive for the presence of drugs or alcohol. I will be ineligible for employment with the company.
  • Sign and Date the Form

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