Balance, Inc. is an equal opportunity employer and will consider all applicants for all positions equally without regard to their race, sex, age, color, religion, national origin, veteran status or any disability as provided in the Americans with Disabilities Act.

This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered.


(Note: A conviction will not necessarily disqualify you from employment.)



List names of employers in consecutive order with present or last employer listed first.  Account for all periods of time including military service and any periods of unemployment.  If self-employed, give firm name and supply business references.

Please fill out each box completely and accurately

Employer 1

Employer 2

Employer 3




If you worked in any of your previous positions under another name, please give that name(s) below for reference checking purposes:


Give three references, not relatives or former employers:


I certify that my answers to the foregoing questions are true are true and correct without any consequential omissions of any kind whatsoever.  I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application form or during any interviews may be grounds for may immediate discharge.

I hereby authorize Balance, Inc. to contact any company or individual it deems appropriate to investigate my employment history, character and qualifications and I give my full and complete consent to their revealing any and all information they wish as a result of this investigation.  In addition, I hereby waive my right to bring any cause of action against these individuals for defamation, invasion of privacy or any other reason because of their statements.

I agree that, if I am employed, I will abide by all the rules and regulations of Balance, Inc.  I understand that the taking of drug and alcohol tests, when given pursuant to organization policy, are a condition of continued employment and refusal to take such tests when asked will be grounds for immediate termination.  I further understand that nobody at Balance, Inc. is authorized to enter into any written or verbal employment contracts with me for any definite period of time without the express written consent of the Executive Director or President of the Board.  I also understand that my employment is “at-will” and may be terminated by myself or by the organization at any time for any reason or no reason at all, with or without prior notice.


Balance, Inc. is an Equal Opportunity and Affirmative Action Employer.  As required by law, we must record certain information to be made a part of our Affirmative Act ion Program.

You are invited to participate in the Affirmative Action Program by reporting their race, gender, veteran status and disability status. In extending this invitation you are also advised that:
(a) employees are under no obligation to respond , but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for the necessary data required for our Equal Opportunity Reporting and

Affirmative Action Program. We are a company that values diversity. Refusal to provide this information will have no bearing on your employment status and will not subject you in any adverse treatment.