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Employment Application

APPLICATION FOR EMPLOYMENT

Position applied for

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Date of application (*)

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PERSONAL INFORMATION

Last name (*)

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First name (*)

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Present address (*)

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City (*)

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State (*)

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Zip (*)

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How long? (*)

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Home phone (*)

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Email address

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How were you referred?

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GENERAL INFORMATION

Only U.S. citizens or aliens who have a legal right to work in the U.S. are eligible for employment. Can you, upon employment provide genuine documentation establishing your identity and eligibility to be legally employed in the United States? (*)

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Have you ever been convicted of a crime or violation other than a minor traffic infraction? (a conviction record will not necessarily be a bar to employment. Factors such as job relations, age and time of the offense, seriousness and nature of violation and rehabilitation will be taken into account). (*)

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If yes, please explain:

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Have you ever been discharged from any employment or asked to resign? (*)

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If yes, please explain:

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SCHEDULE AVAILABILITY

Please check schedule availability (*)

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If only available for part-time employment please check the reason:

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Other (explain)

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HOURS AVAILABLE
Please include work availability for each day of the week; both full-time and part-time applicants. Please indicate a.m. or p.m. hours as appropriate.
NOTE: Work schedules are based upon the needs of the business and may be subject to change on a weekly basis.

Monday

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Tuesday

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Wednesday

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Thursday

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Friday

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Saturday

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Sunday

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Date available for work? (*)

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EMPLOYMENT HISTORY
Begin with your most recent employment and continue with all past employment.


EMPLOYER 1:

Company name

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Address

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City

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State

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Zip

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Phone

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Dates of employment

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Type of business

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Job title

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Describe job duties

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Starting salary

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Ending salary

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Reason for leaving

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Name and title of immediate supervisor

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May we contact employer?

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Explain any period between jobs

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EMPLOYER 2:

Company name

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Address

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City

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State

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Zip

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Phone

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Dates of employment

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Type of business

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Job title

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Describe job duties

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Starting salary

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Ending salary

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Reason for leaving

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Name and title of immediate supervisor

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May we contact employer?

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Explain any period between jobs

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EMPLOYER 3:

Company name

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Address

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City

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State

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Zip

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Phone

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Dates of employment

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Type of business

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Job title

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Describe job duties

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Starting salary

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Ending salary

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Reason for leaving

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Name and title of immediate supervisor

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May we contact employer?

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Explain any period between jobs

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EDUCATION HISTORY


HIGH SCHOOL

High School

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High School Address

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Major subject

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Select last year attended

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Graduated high school

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Coursework/Degree

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COLLEGE

College

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College adress

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Major subject

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Years attended

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Graduated college

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Degree

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COLLEGE

College

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College adress

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Major subject

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Years attended

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Graduated college

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Degree

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GRADUATE SCHOOL

Graduate School

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Grad School address

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Major subject

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Years attended

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Graduated graduate school

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Degree

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BUSINESS, TECHNICAL, OTHER

Business, Technical, Other

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Business, Technical, Other address

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Major subject

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Years attended

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Graduate technical/business school

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Degree

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ADDITIONAL EXPERIENCE OR QUALIFICATIONS
List any other experience skills or other qualifications including hobbies, which you believe should be considered in evaluating your qualification for employment. Please indicate any prior military service which you would like to include in connection with your application for employment.

Explain here:

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REFERENCES


REFERENCE 1

Name

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Address

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City, State, Zip

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Phone

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Title/Relationship

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Occupation Business Phone

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How long have you known them?

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REFERENCE 2

Name

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Address

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City, State, Zip

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Phone

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Title/Relationship

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Occupation Business Phone

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How long have you known them?

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NOTIFICATION AND AGREEMENT
Please read before signing.



I CERTIFY THAT ALL ANSWERS GIVEN BY ME ARE TRUE, ACCURATE AND COMPLETE. I UNDERSTAND THAT THE FALSIFICATION, MISREPRESENTATION OR OMISSION OF FACT ON THIS APPLICATION (OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS) WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION FOR EMPLOYMENT REGARDLESS OF WHEN OR HOW DISCOVERED.

Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

It is the policy of the Company to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State or Local Law.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making and investigation.

If hired, I agree to abide by all of the Company rules and regulation, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the company or me, I further understand that no representation, whether oral or written by any representative or agent of the Company, at any time, can constitute a contract of employment. I understand that the Company and all Plan Administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures benefits or other terms or conditions of employment. No representative or agent of the Company has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure benefit or their term or condition of employment other than in a document signed by the President or to make any agreement contrary to the foregoing.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.


You must agree to the terms of the Notification and Agreement. (*)

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