Application For Employment

INSTRUCTIONS:We appreciate your interest in our organization. We consider applicants for all positions without regard to race, color, creed, age, religion, sex, disability or handicap, marital status, national origin, veteran status or arrest/conviction record.
Position(s) applied for
How did you learn about us?
Advertisement Employment Agency Walk-in Other
First Name Middle Initial Last Name
E-mail Address
Street Address
City State Zip Code
Social Security Number Phone Number
Any other name(s) under which you have been previously employed or under which school records would be located
Names of friends or relatives employed in this organization
If you are under 18 years of age, can you furnish a work permit? 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 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)
Do you have any restrictions or obligations that would prevent you from working overtime? Yes No
Do you have any restrictions or obligations that would prevent you from working consistently or arriving to work on time? Yes No
On what date would you be available to work?
Are you available to work: Full Time Part Time Shift Work Temporary
Can you travel if the job requires it? Yes No
If Yes, are there limitations? Explain.
Have you been convicted of a crime? Yes No
(Conviction will not necessarily disqualify an applicant from employment)
If Yes, please list dates of offenses and dispositions.
Have you ever had any job-related training in the United States military? Yes No
If Yes, please describe:
If you are applying for a driver position, please provide the following information about your driver's license
License# Exp. Date State: DOB:
Employment Experience - Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude voluntary work which indicates race, color, religion, gender, national origin, handicap or other protected status. Please account for all time for at least the past five years.
Employer Dates Employed: From To
Street City State Zip Code
Telephone number(s) Hourly Rate/Salary: Starting Final
Job title Supervisor
Reason for leaving May we contact this employer? Yes No
Employer Dates Employed: From To
Street City State Zip Code
Telephone number(s) Hourly Rate/Salary: Starting Final
Job title Supervisor
Reason for leaving May we contact this employer? Yes No
Employer Dates Employed: From To
Street City State Zip Code
Telephone number(s) Hourly Rate/Salary: Starting Final
Job title Supervisor
Reason for leaving May we contact this employer? Yes No
Employer Dates Employed: From To
Street City State Zip Code
Telephone number(s) Hourly Rate/Salary: Starting Final
Job title Supervisor
Reason for leaving May we contact this employer? Yes No
Employer Dates Employed: From To
Street City State Zip Code
Telephone number(s) Hourly Rate/Salary: Starting Final
Job title Supervisor
Reason for leaving May we contact this employer? Yes No
Education

Elementary School
School Name
Location
Years Completed
Diploma/Degree
Date of Completion
Course of Study

High School
School Name
Location
Years Completed
Diploma/Degree
Date of Completion
Course of Study

Undergraduate College/University
School Name
Location
Years Completed
Diploma/Degree
Date of Completion
Course of Study

Graduate/Professional
School Name
Location
Years Completed
Diploma/Degree
Date of Completion
Course of Study
Additional Information - Please complete the items below that are relevant to your ability to perform the position for which you are applying.
Describe any specialized training, apprenticeship, skills and extra-curricular activities
Describe any honors you have received
State any additional information you feel may be helpful to us in considering your application
References - Give name, relationship, address and telephone number of three references who are qualified to evaluate your capabilities and who are not related to you and are not previous employers.
Special Skills and Qualifications - Summarize special job-related skills and qualificatoins acquired from employment or other experience. Those applying for clerical positions, please indicate typing speed and familiarity with word processing and other office equipment.
Applicants Statement
I certify that answers given herein are true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in withdrawal of an offer of employment, or if subsequent to employment, may result in dismissal.
I understand this employment application is not to be construed as a guarantee of employment. I further understand that, should I become employed, my employment with the organization does not constitute any form of contract, implied or expressed, and such employment may be terminated at will either by myself or my employer upon notice of one party to the other. My continued employment would be dependent on satisfactory performance and the continued need for my services as determined by the organization.
I Authorize investigation of all statements contained in this aplication for employment as may be necessary in arriving at an employment decision. You may use this authority to check references with former employees I have listed, unless otherwise indicated, as well as the personal references listed.