Employment

Application for Employment
How do you learn about us?
- Advertiseent
- Relative
- Inquiry
- Employment Agency
- Friend
- Other
Name*
First Middle Last
Address
Street Address City State ZIP Code
Telephone Numbers*
Best time to contact you at home is (AM/PM):
If you are under 18 years of age, can you provide required proof of your eligibility to work?
- Yes
- No
If Yes, Give Date:
Have you ever filled an application form with us before?
- Yes
- No
Have you ever been employed us before?
- Yes
- No
If Yes, Give Date:
Do any of your friends or relatives, other than spouse, work here?
- Yes
- No
Are you currently Employed?
- Yes
- No
May we contact your present employer?
- Yes
- No
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Are you prevented from lawfully becoming employed in this country because of visa or immigration staus:
Proof of citizenship or immigration status will be required upon employment
- Yes
- No
Date available for work
What is your desired salary range?
Are you available to work:
- Full time
- Part Time
- Temporary
Are you currently on "lay-off" status and subject to recall?
- Yes
- No
Can you travel if a job requires it?
- Yes
- No
Have you been convicted of a felony within the last five years?
- Yes
- No
Education
Elementary School
Name and address of School
Course of Study
Number of Years Completed
Diploma Degree
High School
Name and address of School
Course of Study
Number of Years Completed
Diploma Degree
Undergraduate College
Name and address of School
Course of Study
Number of Years Completed
Diploma Degree
Graduate Professional
Name and address of School
Course of Study
Number of Years Completed
Diploma Degree
Other Specify
Name and address of School
Course of Study
Number of Years Completed
Diploma Degree
Describe any specialized training, apprenticeship, skills and extra-curricular activities
Describe any job-related training received in the United States military.
Employment Experience
Start with your present or last job. Included 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(s)
Job Title
Supervisor
Date Employed From
Date Employed To
Hour Rate/Salary (Starting)
Hour Rate/Salary (Final)
Reason for leaving
Work Performed
2. Employer
Address
Telephone Number(s)
Job Title
Supervisor
Date Employed From
Date Employed To
Hour Rate/Salary (Starting)
Hour Rate/Salary (Final)
Reason for leaving
Work Performed
3. Employer
Address
Telephone Number(s)
Job Title
Supervisor
Date Employed From
Date Employed To
Hour Rate/Salary (Starting)
Hour Rate/Salary (Final)
Reason for leaving
Work Performed
4. Employer
Address
Telephone Number(s)
Job Title
Supervisor
Date Employed From
Date Employed To
Hour Rate/Salary (Starting)
Hour Rate/Salary (Final)
Reason for leaving
Work Performed
List professional, trade, business, or civic activities and offices held
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry disability or other protected status:
Additional Information
Other Qualifiacation
Summarize special job related skills and qualifications acquired from employment or other experience.
Specialized Skill (Check the Skill/Equipment Operated)
- Terminal
- PC/MAC
- Typewriter
- WPM
- Spreadsheet
- Word Processing
- Shorthand
Production/Mobile Machinery (List)
Other List
State any additional information you feel may be helpful to us in considering your application
Note to applicant: Do not answer this question unless you have been informed about the requirement of the job for which you are applying
Can you perform the essential functions of job, for which your are applying either with or without a reasonable accommodation?
- Yes
- No
1. Reference
Name
Phone
Address
2. Reference
Name
Phone
Address
3. Reference
Name
Phone
Address
Applicant Statement
I certify that answer given herein are true and complete.

I authorize investigation of all statements contain in this application for employment as may be necessary be in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organizations is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such changes is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also, that i am required to abide by all rules and regulations of the employer.
Security