Jobs Employment, Career Job, Employment Job
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It is our policy to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental handicap, or veteran status.
Name: Last __________ First __________ Middle _________ Date __________
Street Address ______________________________________________________
City ______________________ State ____________ Zip _________________
Telephone ( ) ________________ Social Security # ____________________
Position applied for ___________________________________________________
How did you hear of this opening ________________________________________
When can you start _____________________ Desired Wage $ ______________
Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis?
[ ] Yes [ ] No
Are you looking for full time employment? [ ] Yes [ ] No
If no, what hours are you available? _______________
Are you willing to work swing shift? [ ] Yes [ ] No
Are you willing to work graveyard? [ ] Yes [ ] No
Have you ever been convicted of a felony? [ ] Yes [ ] No
If yes, please fully describe the circumstances: _________________________________________ _____________________________________________________
Education: School Name and Location Year Major Degree
High School _____________________________________________________
College _____________________________________________________
College _____________________________________________________
Other _____________________________________________________
_____________________________________________________
In addition to your work history, are there are other skills, qualifications, or experience we should consider:
_____________________________________________________ _____________________________________________________
Employment History: (Start with most recent employer.)
Company name _______________________
Address __________________________________ Telephone _________________
Date Started _______ Starting Wage _______ Starting Position ___________
Date Ended ________ Ending Wage _______ Ending Position ___________
Name of Supervisor ________________ May we contact? [ ] Yes [ ] No
Responsibilities _____________________________________________________
Reason for leaving _____________________________________________________
Company name _______________________
Address __________________________________ Telephone _________________
Date Started _______ Starting Wage _______ Starting Position ___________
Date Ended ________ Ending Wage _______ Ending Position ___________
Name of Supervisor ________________ May we contact? [ ] Yes [ ] No
Responsibilities ________________________________________________________
Reason for leaving ______________________________________________________
Company name _______________________
Address __________________________________ Telephone _________________
Date Started _______ Starting Wage _______ Starting Position ___________
Date Ended ________ Ending Wage _______ Ending Position ___________
Name of Supervisor ________________ May we contact? [ ] Yes [ ] No
Responsibilities _____________________________________________________
Reason for leaving _____________________________________________________
Attach additional information if necessary.
I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history. I understand that employment at this company is "at will," which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment will continue on that basis. I understand that no supervisor, manager, or executive of this company, other than the president has the authority to alter the foregoing.
Signature _________________________ Date ____________________
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