Employment Application

Application For Employment

We consider applicants for all positions without regard to race, color, religion, sex, natural origin, age marital or veteran status, the presence of a non-job related medical condition or handicap, or any other legally protected status.

(PLEASE PRINT)

Position Applied For	Date of Application
How did you learn about us? Advertisement Friend Walk-In Employment Agency Relative Other__________________
Last Name First Name Middle Name
Address: Number Street City State Zip Code
Telephone Number(s) Social Security Number _______-________-________
ave you ever filed an application with us before? If yes, give date:		Yes	No
Have you ever been employed with us before?		Yes	No
Are you currently employed?		Yes	No
May we contact your present employer		Yes	No
Are you 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		Yes	No
On what date will you be available for work?		Yes	No
Are you available to work: Full Time Part Time Temporary
Are you currently on lay-off status and subject to recall?		Yes	No
Can you travel if a job requires it?		Yes	No
Have you ever been convicted of a felony within the last 7 years? Conviction will not necessarily disqualify an applicant from employment		Yes	No
If yes, please explain:

EDUCATION

	Elementary School	High School	Undergraduate Collage/University	Graduate / Professional
School Name and Location
Years Completed	4___5___6___7___8	9__10__11__12__	1___2___3___4__	1___2___3___4_
Diploma/Degree

Describe any specialized training, skills and extra curricular activities ____________________________________________________________________________________________

____________________________________________________________________________________________

Describe any honors you have received

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

_____________________________________________________________________________________________

Indicate any foreign languages you can speak, read and/or write

	FLUENT	GOOD	FAIR
SPEAK
READ
WRITE

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

You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, or handicap or other protected status:

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________

REFERENCES

Give name, address and telephone number of three references who are not related to you and are not previous employers.

1.____________________________________________________________________________________________

2.____________________________________________________________________________________________

3.____________________________________________________________________________________________

Have you ever had any job related training in the United States military? Yes No

If yes, please describe __________________________________________________________

Are you physically or otherwise unable to perform the duties of the job for which you are applying? Yes No

EMPLOYMENT EXPERIENCE

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations that indicate race, color, religion, gender, national origin, handicap or other protected status.

Employer	Dates From________ To _________	Work Performed
Address
Telephone Number(s)	Salary Starting_______ Final_______	Job Title
Reason for Leaving		Supervisor

Employer	Dates From__ ______To__________	Work Performed
Address
Telephone Number(s)	Salary Starting_______Final________	Job Title
Reason for leaving		Supervisor

Employer	Dates From________To__________	Work Performed
Address
Telephone Number(s)	Salary Starting________Final_______	Job Title
Reason for leaving		Supervisor

Employer	Dates From________To__________	Work Performed
Address
Telephone Number(s)	Salary Starting________Final_______	Job Title
Reason for leaving		Supervisor

If you need additional space, please continue on a separate sheet of paper.

Special Skills and Qualifications

Summarize special job related skills and qualifications acquired from employment or other experience.

____________________________________________________________________________________________

Applicant’s Statement

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

·I authorize an investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

·This application for employment shall be considered active for a period of time not to exceed 45 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 given 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.

_______________________________ ____________________

Signature of Applicant Date

FOR PERSONNEL DEPARTMENT USE ONLY

Arrange Interview Yes No

Remarks _____________________________________________________________________

______________________________________________________________________

Interviewer _______________________________________ Date _______________________

Presently employed? Yes No Date of employment _______________________

Job Title ________________________ Salary ______________________

NOTES:

___________________________________________________________

Date of Application

How did you learn about us?

Last Name First Name Middle Name

Address: Number Street City State Zip Code

Telephone Number(s) Social Security Number

ave you ever filed an application with us before?

Yes

No

Have you ever been employed with us before?

Yes

No

Are you currently employed?

Yes

No

May we contact your present employer

Yes

No

Are you prevented from lawfully becoming employed in this

Country because of Visa or Immigration Status?

Yes

No

On what date will you be available for work?

Yes

No

Are you available to work: Full Time Part Time Temporary

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

Yes

No

Can you travel if a job requires it?

Yes

No

Have you ever been convicted of a felony within the

last 7 years?

Conviction will not necessarily disqualify an applicant from employment

Yes

No

If yes, please explain:

EDUCATION

Elementary School

Have you ever had any job related training in the United States military? Yes No

Special Skills and Qualifications