Application for Employment

KSMS is an equal opportunity employer and does not discriminate on the basis of age, race, color, religion, gender, sexual orientation, gender identity, gender expression, national origin, protected veteran status, disability or any other legally protected status.

Personal Information


Licenses and Trade Organizations

Employment History

Professional/Personal References

The information provided in this application is true, correct and complete. If employed, and misstatement or omission of fact in this application may result in termination of employment.

If I sustain any injury or illness while in the employment of KSMS, I agree that KSMS and its affiliates and representatives shall be entitled to receive full and complete reports and records covering any medical or related examinations, and I authorize any and all such doctors, medical examiners and hospitals to provide KSMS, its insurers, agents, successors and assigns full and complete reports and records covering such examinations, condition, care and treatment related to or resulting from any alleged illness or injury.

Authorizations and Release
If I am given a conditional offer of employment, I authorize KSMS to obtain a complete investigation of me, including but not limited to, my past employment history, medical history, educational background, criminal activity, motor vehicle driving records and workers' compensation history and to rely on such information. I authorize all persons and organizations to release any of the above-described information and hereby release all persons and organizations from any liability whatsoever related to provision of any such information. I acknowledge that an electronic copy of this authorization and release shall be as valid as the original.

I understand that an offer and acceptance of employment is not an agreement to continue employment, and any employment is at-will.