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(List below all present and past employment for the last ten years beginning with the most recent)

Company #1

Company #2

Company #3


(List business or professional person known, but not related to you, for at least three years)

Reference #1

Reference #2

Reference #3




The above information is true and complete to the best of my knowledge. Should I be employed by the Agency, any misrepresentation or false statement contained herein may be considered cause for possible dismissal. The Agency has my permission to obtain all necessary information from the references I have listed, or any other sources, concerning my prior employment, personal history, or credit standing and I release all parties from any possible damages resulting from disclosing such information with or without prior written notice to me. I reserve the right to know the names and addresses of any investigative agencies used in order that I may learn the information contained in any reports furnished to the Agency.

I understand that this application does not constitute an employment contract of any kind. Should I be employed by the Agency, I may resign such employment at any time at my discretion with or without prior notice, and the Agency may terminate my employment at any time at their discretion, with or without cause and with or without prior notice.

I understand that it is DILA's policy to run background and MVA checks on all applicants.

Mail, email or fax a separate Letter of Interest, indicating which position you are applying for, along with your resume.

By clicking the 'Submit Form' button below, I attest that the above information is true and complete to the best of my knowledge.

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806 Snow Hill Road, Salisbury, MD 21804 | V/TTY: 410-742-5052 | VP: 443-365-2645 | Fax: 410-543-4874
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