Employment Application

Applicants are considered for all positions without regard to race, color, religion,sex, national origin, age, marital or veteran status, or the presence of a non-job related medical condition or handicap.

Date of Application*

POSITION APPLIED FOR:*

HOW DID YOU LEARN ABOUT THIS POSITION?*

If employment agency, please list.

PERSONAL INFORMATION

Last Name*

Middle

First*

TELEPHONE:*

EMAIL:*

ARE YOU 18 YEARS OF AGE OR OLDER?*

If hired, you may be required to provide proof of age.

Yes
No

ARE YOU LEGALLY AUTHORIZED TO WORK IN THE UNITED STATES?*

Proof of eligibility will be required upon employment.

Yes
No

HAVE YOU BEEN CONVICTED OF A FELONY WITHIN THE LAST 7 YEARS?*

Yes
No

If yes, please explain:*

(A conviction will not necessarily disqualify you from employment.)

YOUR AVAILABILITY

DATE YOU ARE AVAILABLE TO START:*

DO YOU WISH TO WORK:*

Full-Time
Part-Time
Temporary

IF TEMPORARY, SPECIFY DATES AVAILABLE:*

PLEASE INDICATE HOURS YOU ARE AVAILABLE TO WORK EACH DAY:*

Example: 7am - 9pm

WAGES DESIRED:*

PER*

HOURS PER WEEK:*

CAN YOU TRAVEL IF YOUR JOB REQUIRES IT?*

Yes
No

YOUR SKILLS AND EXPERIENCE

(Check all that apply)*

What languages?*

List any other relevant qualifications you have that can be a benefit in this position:

YOUR EDUCATION

High School*

Name & Location	Years Completed	Type of Degree & Graduation Date	Major(s)

College

Name and Location	Years Completed	Type of Degree & Graduation Date	Major(s)

Grad School

Name and Location	Years Completed	Type of Degree & Graduation Date	Major(s)

Other

Name and Location	Years Completed	Type of Degree & Graduation Date	Major(s)

YOUR EMPLOYMENT HISTORY

Please provide the names and addresses of all previous employers. If you are now working, your present employer and reasons you want to leave must be included. Please give reason for any lapse of time between jobs.

MAY WE CONTACT YOUR PRESENT EMPLOYER?:*

YES
NO

Employer (latest first)

Employer (latest) Phone

Supervisor 1 Name:

First Last

Employed From:

Employed To:

If still employed here, don't fill in the date.

Work Performed:

Reason for Leaving

Hourly Rate/Salary to Start:

Hourly Rate/Salary Final

Employer (second)

Employer (second) Phone

Supervisor 2 Name:

First Last

Employed From:

Employed To:

If still employed here, don't fill in the date.

Work Performed:

Reason for Leaving

Hourly Rate/Salary to Start:

Hourly Rate/Salary Final

Employer (third)

Employer (third) Phone

Supervisor 3 Name:

First Last

Employed From:

Employed To:

If still employed here, don't fill in the date.

Work Performed:

Reason for Leaving

Hourly Rate/Salary to Start:

Hourly Rate/Salary Final

Employer (fourth)

Employer (fourth) Phone

Supervisor 4 Name:

First Last

Employed From:

Employed To:

If still employed here, don't fill in the date.

Work Performed:

Reason for Leaving

Hourly Rate/Salary to Start:

Hourly Rate/Salary Final

Employer (fifth)

Employer (fifth) Phone

Supervisor 5 Name:

First Last

Employed From:

Employed To:

If still employed here, don't fill in the date.

Work Performed:

Reason for Leaving

Hourly Rate/Salary to Start:

Hourly Rate/Salary Final

YOUR REFERENCES

Please list 3 professional references (not related to you) with contact information

Click on the + sign at the end of the row to add blank lines.

Name:	Phone Number:	Email:	How do you know this person?	Years acquainted?

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING

THIS APPLICATION IS CONSIDERED CURRENT FOR 90 DAYS. IF YOU WANT TO BE CONSIDERED FOR EMPLOYMENT AFTER THIS TIME, YOU MUST RENEW YOUR APPLICATION IN WRITING.

I certify that all information provided in the employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre-and/or post- employment drug screen as a condition of employment, if required. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. I understand that if I am hired, I am required to abide by all rules and regulations of the Company.

I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENT OF THIS ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE.

I have read, understand, and by my signature consent to these statements.

Phone
This field is for validation purposes and should be left unchanged.