Employment Application

Position(s) Applied for:

Have you previously been employed by Reno Diagnostic Centers?

Yes No

If Yes, when?

If your application is considered favorably, on what date will you be available for work?

(Last, First Middle)

Social Security #:

E-Mail Address:

Present Address





Telephone Number:

Cellular Number:

Are you legally eligible for employment in the USA?

Yes No

Are you of the legal age to work?

Yes No

Are you a citizen of the USA?

Yes No

Have you ever been convicted of a felony?

Yes No

If yes, please explain:






Intermountain Disposal

P.O. Box 1596 • Portola, California 96122-1596
Phone 530-832-4879    Fax 530-832-4934
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