APPLICATION FOR EMPLOYMENT

Prospective employees will receive consideration without discrimination based on race, creed color, sex, age,
national origin, handicap, veteran status or any condition prescribed by state or local law.

Personal Information

Last Name: First Name:
Middle: 		 Date of birth:  (mm/dd/yyyy)
Street Address:
City:   State:   Zip: 
Home Telephone:
E-Mail Address:
Business Telephone:
Have you ever applied for employment with us?
Yes No ..........If yes: Date  (mm/yy) Location:
 
Position Desired:
Social Security #:
- -
Apart from absence for religious observance, are you available to work full-time?
Yes No............If not, what hours can you work?
Desired Pay:
Are you legally eligible for employment in the United States?
Yes No
Will you work overtime if asked?
Yes No
Have you been convicted of any crimes in the past ten years, excluding misdemeanors and summary offenses, which have not been annulled, expunged or sealed by a court?
Yes No ................If "yes", describe in full:
When will you be available to begin work?
 (mm/dd/yyyy)
Other special training or skills {languages, machine operation, etc.}
Have you ever been bonded?
Yes No
If "yes", with what employers?

 

Education
School
Name and Location of School
Course of study
No. of years completed
Did you graduate?
Degree or Diploma
Graduate
Yes
No
College

Yes
No
Business/Trade/Technical

Yes
No
High School
Yes
No
Elementary
Yes
No

 

Employment

Please give accurate, complete full-time and part-time employment record.
Start with your present or most recent employer first.

1
Company Name:
Telephone:
Address:

Employed-
From...  (mm/yy) ...To  (mm/yy)

Name of Supervisor:
Weekly pay
Start.. .. Last
State Job Title and Describe Your Work:
Reason for leaving:

2
Company Name:
Telephone:
Address:

Employed-
From...  (mm/yy) ...To  (mm/yy)

Name of Supervisor:
Weekly pay
Start.. .. Last
State Job Title and Describe Your Work:
Reason for leaving:

3
Company Name:
Telephone:
Address:

Employed-
From...  (mm/yy) ...To  (mm/yy)

Name of Supervisor:
Weekly pay
Start.. .. Last
State Job Title and Describe Your Work:
Reason for leaving:

4
Company Name:
Telephone:
Address:

Employed-
From...  (mm/yy) ...To  (mm/yy)

Name of Supervisor:
Weekly pay
Start.. .. Last
State Job Title and Describe Your Work:
Reason for leaving:

5
Company Name:
Telephone:
Address:

Employed-
From...  (mm/yy) ...To  (mm/yy)

Name of Supervisor:
Weekly pay
Start.. .. Last
State Job Title and Describe Your Work:
Reason for leaving:

We may contact the employers listed above unless you indicate those you do not want us to contact.
Do Not Contact
Employer Number: ...Reason:

 

 

Military
 Did you serve the in the U.S. Armed Forces? Yes No

If "yes", in what Branch?

Describe any training received relevant to the position you are applying for.

 

 

 

Applicant Signature
Please Read Carefully

The information I have provided in this Application for Employment is true, correct and complete. False, incomplete or misrepresented information of any kind, will be sufficient cause for my application to be rejected or, if discovered after I am employed, cause for immediate termination of my employment.

I authorize the employer to contect and obtain information about me from previous employer, educational institutions and "references" I provide, and any other party necessary to verify the accuracy of information I disclose in this application, a related employment resume or a personal interview. To assist in the processing of my application, I waive all rights and claims I may otherwise have against the employer or its representative, for seeking, and using information to evaluate my employment request and all other persons, corporations or organizations who provide information for this purpose.

This application will expire in 30 days. After that date, unless otherwise notified, I understand that my status as an applicant will end. I may re-apply for employment in the future by completing a new application.

This application is not an employment agreement. If I accept an offer of employment, I understand I may resign at any time, and the employer may terminate my employment at any time, with or without cause and without prior notice, unless required by law. I understand the no one, other than an executive officer of the employer, has authority to enter into any employment agreement with terms contrary to the foregoing and then only in writing signed by such officer.

I have read the terms. I fully understand and accept all terms and conditions in the above statment.
I do not understand or accept the terms in the above agreement.
Todays Date:  (mm/dd/yyyy)