Employment Application

Applying for:

Applicant Name

Last:    First:    Middle:

Street:  City:   State:   Zip:

Phone Number: 000-000-0000

Email Address:

We are an equal opportunity employer
Applications are received and employees are hired without regard to race, creed, color, sex, religion, age, national origin, marital status, physical or mental handicap, disability, sexual orientation, veterans status, citizenship status, or any other protected classes under state, local, or county regulations. The receipt of this application does not mean that job openings exist and does not obligate us in any way. We appreciate your interest in our organization.

All questions must be answered. State "N/A" If question is not applicable.

This is a drug free workplace


Personal Information

Date of Application --/--/---- Possible Start Date --/--/----

Are you available to work

Times available for work
SuMoTuWeThFrSa

How where you referred to us?

Have you filed an application here before?

Have you ever been employed here before?

Are you employed now?

Does your present employer know of your plans to change employment?

Why do you desire to make a change?

Are you on a layoff and subject to recall?

Have you ever been discharged or requested to resign from a position?

If yes explain?

How much time have you lost from work during the last 12 months?

Do you have steady transportation to work?

Can you travel if a job requires it?

Have you ever held a position of trust (handling money)?

Have you ever been refused Bond?
If Yes, Please explain

Are you legally eligible to work in the United States?
Proof of citizenship/immigration status & identity is required upon employment

Have you ever been convicted of or received a sentence for a crime(s) other than a minor traffic violation? ("Yes" is not an automatic bar to employment)
If so, state date, court and place where offense(s) occurred

Do you hold a valid drivers license? List State

Have you been convicted of any moving violation(s) in the last 3 years?
If Yes, give date(s) and explanation

List three things that are important to you in a work environment
1.
2.
3.

List three things that best describe you
1.
2.
3.

Why do you want to work here?

Full Employment History (Must be completed even when accompanied by resume)
Start with your present or last job. Include ALL assignments and positions held. Be specific about information and dates.

Complete work History MUST be provided. All Employment "Gaps" must be listed"

Employer
Job Title
Hourly Rate Starting Ending
Address (Street City and State)
Phone 205-000-0000
Dates Employed to Month/Year
Summary of Work Performed and Job Responsibilities

State Reason

Employer
Job Title
Hourly Rate Starting Ending
Address (Street City and State)
Phone 205-000-0000
Dates Employed to Month/Year
Summary of Work Performed and Job Responsibilities

State Reason

Employer
Job Title
Hourly Rate Starting Ending
Address (Street City and State)
Phone 205-000-0000
Dates Employed to Month/Year
Summary of Work Performed and Job Responsibilities

State Reason

Employer
Job Title
Hourly Rate Starting Ending
Address (Street City and State)
Phone 205-000-0000
Dates Employed to Month/Year
Summary of Work Performed and Job Responsibilities

State Reason

Special Skills and Qualifications
Summarize special skills and qualifications acquired from employment or other experience

List professional, trade, business or civic activities and offices held

Computer skills (list programs and proficiency level)

What foreign lanuages do you speak, read and/or write?

Education Information

Schooling Years Degree Rec & Major Location Graduated?
High School
Degree/Major
College
Graduate School

Military Service
Branch of Service and Serial Number

Present Selective Service Classification

Rank at Discharge

List Duties/Special Training

Agreement

The facts set forth above in my application for employment are true and complete. I understand that false statements or omission of information on this application or any other employment form may lead to dismissal or denial of employment. You are hereby authorized to make any investigation of my personal history, financial, criminal, credit, and motor vehicle records through any investigative or credit agencies or bureaus of your choice. You are also authorized to administer personality profile tests and verify my background. A criminal record or sentence is not a automatic disqualification for employment. I agree to submit to any drug or alcohol testing prior to or after employment and I agree to submit to a medical evaluation, if required.

In making this application for employment, I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends or others with whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics, and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigative consumer report. In exchange for the consideration of my employment application by this company, I hereby release and forever discharge the company (including its directors, officers, employees, and agents) and my past and/or present employers (their directors, officers, employees, and agents) from any liabilities which may result from an investigation of my past and/or present employment or from the disclosure of such information. I authorize the use of any information in this application to verify my statements, and I authorize the past employers, doctors, all references and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record.

I understand that if my application is accepted that employment with this company at all times is employment "at will". It is further understood that this "at will" relationship may not be changed by any written document, verbal statements, or by conduct unless such change is specifically acknowledged by an authorized executive of the company. I further understand that my "at will" employment may be terminated at any time by myself or the company and includes no guarantee, contract or promise of employment for any specific length of time. I understand that the first ninety(90) days of employment is a new hire introductory period.

Confirmation

Please check here showing you have read and understand