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Employment Application2017-02-10T20:54:44-06:00

Application for Employment

    Position(s) Applying For

    Date of Application

    How did you learn about us?

    AdvertisementFriendWalk-inRelativeOther

    Other Reason:

    Pay Expected:

    Last Name

    First Name

    Middle Initial

    Address

    Number

    Street

    City

    State

    Zip Code

    Home Phone

    Business Phone

    Social Security Number

    If you are under 18 years of age, can you provide required proof of your eligibility to work?

    YesNo

    Have you ever filed an application with us before?

    YesNo

    If yes, give date:

    Have you ever been employed with us before?

    YesNo

    If yes, give date:

    Are you currently employed?

    YesNo

    May we contact your current employer?

    YesNo

    Are you currently prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
    Proof of Citizenship or Immigration status will be required upon employment.

    YesNo

    On what date would you be available for work?

    Are you available to work:

    Full TimePart TimeSummerTemporary

    Are you currently on "lay off" status and subject to recall?

    YesNo

    Can you travel if a job requires it?

    YesNo

    Can you work overtime if a job requires it?

    YesNo

    Have you been convicted of a felony within the last 7 years?
    Conviction will not necessarily disqualify an applicant from employment.

    YesNo

    If Yes, please explain.

    Education

    High School

    Name & Address

    Years Completed

    Diploma Earned?

    YesNo

    Undergraduate College

    Name & Address

    Course of Study

    Years Completed

    Diploma/Degree Earned?

    YesNo

    Graduate Professional

    Name & Address

    Course of Study

    Years Completed

    Diploma/Degree Earned?

    YesNo

    Other Education

    Other (Please specify):

    Describe any specialized training, apprenticeship, skills, and extra-curricular activities.

    OTHER QUALIFICATIONS: Summarize special job-related skills and qualifications acquired from employment or other experiences. (Include courses in accounting, sales, finance, & management.)

    Specialized Skills

    If applicable, list the years of experience for each of the skills listed below.

    Fax Machine

    Personal Computer Skills

    Calculator

    Word Processing

    Typewriter

    Spreadsheet

    Sales

    Cash Handling

    Employment Experience

    Start with your present or last job. Include 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.

    Employer 1

    Employer

    Employed Start Date:

    Employed End Date (If still employed, choose today's date)

    Phone Number

    Address

    Street

    City

    State

    Zip Code

    Job Title

    Supervisor

    Starting Salary

    Final Salary

    Reason For Leaving

    Work Performed

    Employer 2

    Employer

    Employed Start Date:

    Employed End Date

    Phone Number

    Address

    Street

    City

    State

    Zip Code

    Job Title

    Supervisor

    Starting Salary

    Final Salary

    Reason For Leaving

    Work Performed

    Employer 3

    Employer

    Employed Start Date:

    Employed End Date

    Phone Number

    Address

    Street

    City

    State

    Zip Code

    Job Title

    Supervisor

    Starting Salary

    Final Salary

    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.

    State any additional information you feel may be helpful to us in considering your application.

    NOTE TO APPLICANTS: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
    Are you capable of performing in a reasonable manner, with or without reasonable accommodation, the activities involved in the job or occupation for which you have applied? A description of the activities involved in such a job or occupation can be found here.

    YesNo

    References

    1

    Name

    Phone Number

    Address

    2

    Name

    Phone Number

    Address

    3

    Name

    Phone Number

    Address

    Confirmation of Authenticity

    I certify that answers give herein are true and complete to the best of my knowledge.

    I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. If you decide to engage an investigative consumer reporting agency to report on my credit and personal history, I authorize you to do so. If a report is obtained you must provide, at my request, the name of the agency so I may obtain from them the nature and substance of the information contained in the report.

    This application for employment shall be considered active for a period of time not to exceed 180 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 organization 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 change is specifically acknowledged in writing by an authorized executive of this organization.

    In the event of employment, I understand that false or misleading information give 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.

     

    I accept these terms as listed above and use this box as my digital signature.

    Today's Date

    Background Check Approval

    Applicant Name

    Date

    Social Security Number

    Date of Birth

    I hereby give permission to have my prospective employer conduct a background check on myself for purpose of consideration for employment by this company.

    I understand that the results of the background check will be kept strictly confidential and used only for the consideration of employment.

    I accept these terms as listed above and use this box as my digital signature.