Application for Employment

*Required Fields

Position Applied for*

Date of Application

How did you learn about us? Advertisement Employment Agency Friend Relative Walk-In Other

If other, explain:

If you are under 18 years of age, can you provide required proof of your eligibility to work?
Yes No

Have you ever filed an application with us before? Yes No

If yes, give date:

Have you ever been employed with us before? Yes No

If yes, give date:

Are you currently employed?* Yes No

May we contact your present employer?* Yes No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?*
Yes No
Proof of citizenship or immigration status will be required upon employment.

On what date would you be available for work?

Are you available to work: Full-time Part-time Shift Work Temporary

Are you currently on "layoff" status and subject to recall? Yes No

Have you ever been convicted of a felony? Yes No

If Yes, please explain:

Name and Address of School*

Course of Study*

Years Completed*

Diploma*

Undergraduate College

Name and Address of School:

Course of Study:

Years Completed:

Degree:

Graduate/Professional

Name and Address of School:

Course of Study:

Years Completed:

Degree:

Other (Specify)

Name and Address of School:

Course of Study:

Years Completed:

Degree:

Describe any specialized training, apprenticeship, skills and extracurricular activities.*

Describe any job-related training received in the United States military.

Additional Information

Other Qualifications:
Summarize special job-related skills and qualifications acquired from employment or other experience.

Specialized Skills

Check skills/equipment operated:

PC Windows/MAC Microsoft Word
Microsoft Excel Microsoft Access PowerPoint

Are you proficient with any other computer softward packages not listed above?

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations, which indicate race, color, religion, gender, national origin, disabilities, or other protected status.

1. Employer*

Address*

Telephone Number*

Work Performed*

Dates Employed From* To*

Hourly Rate/Salary Starting* Final*

Job Title*

Supervisor*

Reason for leaving*

2. Employer

Address

Telephone Number

Work Performed

Dates Employed From To*

Hourly Rate/Salary Starting Final

Job Title

Supervisor

Reason for leaving

List professional, trade, business or civic activities and offices held.
(You may exclude membership that would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status.)

References

1. Name*

Phone Number*

Address*

2. Name*

Phone Number*

Address*

3.. Name*

Phone Number*

Address*

(Please read next section in it's entirety before submitting.)

Applicant's Statement

I understand that this application will be given every consideration, but it is not a promise of employment.

I understand that if I am hired, my employment will be for no definite period, regardless of the period of payment of my wages. I further understand that I have the right to terminate my employment at any time with or without notice, and the Company has the same right. No one other than the President of the Company has the authority to modify this relationship or to make any agreement to the contrary. Any such modification or agreement must be in writing.

I understand that the company may investigate my driving record. I further understand that the Company may contact my previous employers and references. I authorize those employers and references to disclose all pertinent information and records to the Company.

I hereby state that all the information that I provide on this application and in any interview is true and accurate. I understand that if I am employed and any such information is found to be false in any respect, I may be dismissed.

I certify that the information provided by me is correct. I also understand that you will be checking with credit reporting agencies. I authorize an investigation of my credit and employment history and the release of information about my credit experience.

I agree to all of the above. * Yes No

DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE STATEMENT

* Please key in the access code above for verification.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER