Application

Position(s) Applying For

Type of Work Desired*

Full-time
Part-time
Temporary

Date Available to Start Work*

Personal Information

Name*

First Middle Initial Last

Email

Address*

Street Address Address Line 2 City State ZIP Code

Daytime Phone*

Evening Phone*

Have you ever applied for a job with this company in the past?*

Yes
No

If yes, please give the date of application and the position for which you applied. State your name at the time, if different from present name.

Have you ever been employed by this company in the past?*

Yes
No

If yes, please give dates of employment, position held, and state your name while employed, if different from present name.

If hired, will you be able to work during the normal days and hours required for the position(s) for which you are applying?*

Yes
No

If no, please explain.

Do you have any commitments to another employer that might affect your employment with our company?*

Yes
No

If yes, please explain.

If hired, can you furnish proof that you are 18 years of age, or if under 18, do you have a permit to work?*

Yes
No

If no, please explain.

If hired, can you furnish proof that you are eligible to work in the United States?*

(If unsure of the documents needed to prove eligibility to work in the U.S., we will be happy to explain the legal requirements.)

Yes
No

If no, please explain.

Have you been convicted of a felony, or released from prison in the past 10 years?*

Note: A yes answer does not automatically disqualify you from employment since the nature of the offense, date, and type of job for which you are applying will be considered.

Yes
No

If yes, please explain.

Education

Name of High School

Highest Grade Completed

Technical, Vocational, Business or Military Training

Name of School

Location

Did you graduate?

Yes
No

Degree/Diploma Certificate

Major Course of Study

College or University

Name of School

Location

Did you graduate?

Yes
No

Degree/Diploma Certificate

Major Course of Study

Graduate School

Name of School

Location

Did you graduate?

Yes
No

Degree/Diploma Certificate

Major Course of Study

Professional Seminars

Additional job-related seminars, short courses, workshops or other educational experiences.

Job-related certificates, licenses, equipment qualified to operate, computer hardware and software operated, and other job-related special skills and abilities.

Employment History
(List present or most recent employer first)

Employer

Company Name

Address

City

State

Dates of Employment

From

To

Supervisor

Phone Number

Job Title

Duties

Reason for Leaving

Final Salary

Per

May We Contact?

Yes
No

Add Employer

Add Employer

Employer

Company Name

Address

City

State

Dates of Employment

From

To

Supervisor

Phone Number

Job Title

Duties

Reason for Leaving

Final Salary

Per

May We Contact?

Yes
No

Add Employer

Add Employer

Employer

Company Name

Address

City

State

Dates of Employment

From

To

Supervisor

Phone Number

Job Title

Duties

Reason for Leaving

Final Salary

Per

May We Contact?

Yes
No

Please account for any time you were not employed after leaving school in the past ten years.
(You need not list any unemployment periods of one month or less.)

Time Period(s)

Reason(s) for Unemployment

References
List three individuals who are not former employers or relatives.

Name

Phone Number

Email

Occupation

Add Reference

Add Reference

Name

Phone Number

Email

Occupation

Add Reference 2

Add Reference

Name

Phone Number

Email

Occupation

Other Job-related Experience

Some people gain job-related experience in positions other than as an employee. For instance, an accountant may gain experience as a treasure of a civic or school organization, or a manager may gain experience while working on civic projects, or in school organizations, or in PTA activities. Please list and describe any paid or unpaid activities, honors, experience, or training that might aid you in performing the job(s) for which you have applied, and have not been listed previously in this application. (You may omit any activities, honors, memberships or other items that tend to identify your race, sex, national origin, age, disability or other personal traits that you prefer not to disclose).

Please add any additional information (except that which identifies your race, sex, age, religion, national origin, disability or other non-job-related personal information) that you think may be relevant to a decision to hire you.

Important
Please read carefully and enter your initials in the corresponding box for each statement before submitting your application.

By my signature and initials, I promise that the information provided in this employment application (and accompanying resume, if any) is true and complete, and I understand that any false information or significant omissions may disqualify me from further consideration for employment, and may be justification for my dismissal from employment, if discovered at a later date. I agree to immediately notify the company if I should be convicted of a felony, or any crime involving dishonesty or a breach of trust while my job application is pending, or during my period of employment, if hired.*

Enter your initials

I authorize any person, school, current employer (except as previously noted), past employer(s), and organizations named in this application form (and accompanying resume, if any) to provide the company with relevant information and opinion that may be useful to the company in making a hiring decision, and I release such persons and organizations from any legal liability in making such statements.*

Enter your initials

If offered a job that requires it, I give permission for a job-related complete physical examination, and I consent to the release to the company of any medical information, as may be deemed necessary by the company in judging my capability to perform the essential functions of the work for which I am applying (with or without a reasonable accommodations).*

Enter your initials

I understand that if my employment is terminated by the company for dishonesty, breach of trust, or any criminal acts, the authorities may be notified and I may be criminally prosecuted. I also understand that, if hired, I may not hold other employment, nor engage in sales, investments or other activities that create a conflict of interest with the company.*

Enter your initials

I understand that this application does not, by itself, create a contract of employment. I understand and agree that, if hired, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD OF TIME, and may, regardless of the date of payment of wages or salary, BE TERMINATED AT ANY TIME. I understand that NO PERSON IS AUTHORIZED TO CHANGE ANY OF THE TERMS MENTIONED IN THIS EMPLOYMENT APPLICATION FORM.*

Enter your initials

IT IS UNDERSTOOD AND AGREED UPON THAT ANY MISREPRESENTATION BY ME IN THIS APPLICATION WILL BE SUFFICIENT CAUSE FOR CANCELLATION OF THIS APPLICATION AND/OR SEPARATION FROM THE EMPLOYER’S SERVICE IF I HAVE BEEN EMPLOYED.

I GIVE THE EMPLOYER THE RIGHT TO INVESTIGATE ALL REFERENCES AND TO SECURE ADDITIONAL INFORMATION ABOUT ME, IF JOB RELATED. I HEREBY RELEASE FROM LIABILITY THE EMPLOYER AND ITS REPRESENTATIVES FOR SEEKING SUCH INFORMATION AND ALL OTHER PERSONS, CORPORATIONS OR ORGANIZATIONS FOR FURNISHING SUCH INFORMATION.

THE EMPLOYER IS AN EQUAL OPPORTUNITY EMPLOYER. THE EMPLOYER DOES NOT DISCRIMINATE IN EMPLOYMENT AND NO QUESTION ON THIS APPLICATION IS USED FOR THE PURPOSE OF LIMITING OR EXCUSING ANY APPLICANT’S CONSIDERATION FOR EMPLOYMENT ON A BASIS PROHIBITED BY LOCAL, STATE, OR FEDERAL LAW.

THIS APPLICATION IS CURRENT FOR ONLY 60 DAYS. AT THE CONCLUSION OF THIS TIME, IF I HAVE NOT HEARD FROM THE EMPLOYER AND STILL WISH TO BE CONSIDERED FOR EMPLOYMENT, IT WILL BE NECESSARY TO FILL OUT A NEW APPLICATION.

I UNDERSTAND THAT JUST AS I AM FREE TO RESIGN AT ANY TIME, THE EMPLOYER RESERVES THE RIGHT TO TERMINATE MY EMPLOYMENT AT ANY TIME, WITH OR WITHOUT CAUSE AND WITHOUT PRIOR NOTICE. I UNDERSTAND THAT NO REPRESENTATIVE OF THE EMPLOYER HAS THE AUTHORITY TO MAKE ANY ASSURANCES TO THE CONTRARY.

Hidden

IT IS UNDERSTOOD AND AGREED UPON THAT ANY MISREPRESENTATION BY ME IN THIS APPLICATION WILL BE SUFFICIENT CAUSE FOR CANCELLATION OF THIS APPLICATION AND/OR SEPARATION FROM THE EMPLOYER’S SERVICE IF I HAVE BEEN EMPLOYED.

I GIVE THE EMPLOYER THE RIGHT TO INVESTIGATE ALL REFERENCES AND TO SECURE ADDITIONAL INFORMATION ABOUT ME, IF JOB RELATED.  I HEREBY RELEASE FROM LIABILITY THE EMPLOYER AND ITS REPRESENTATIVES FOR SEEKING SUCH INFORMATION AND ALL OTHER PERSONS, CORPORATIONS OR ORGANIZATIONS FOR FURNISHING SUCH INFORMATION.

THE EMPLOYER IS AN EQUAL OPPORTUNITY EMPLOYER.  THE EMPLOYER DOES NOT DISCRIMINATE IN EMPLOYMENT AND NO QUESTION ON THIS APPLICATION IS USED FOR THE PURPOSE OF LIMITING OR EXCUSING ANY APPLICANT’S CONSIDERATION FOR EMPLOYMENT ON A BASIS PROHIBITED BY LOCAL, STATE, OR FEDERAL LAW.

THIS APPLICATION IS CURRENT FOR ONLY 60 DAYS.  AT THE CONCLUSION OF THIS TIME, IF I HAVE NOT HEARD FROM THE EMPLOYER AND STILL WISH TO BE CONSIDERED FOR EMPLOYMENT, IT WILL BE NECESSARY TO FILL OUT A NEW APPLICATION.

I UNDERSTAND THAT JUST AS I AM FREE TO RESIGN AT ANY TIME, THE EMPLOYER RESERVES THE RIGHT TO TERMINATE MY EMPLOYMENT AT ANY TIME, WITH OR WITHOUT CAUSE AND WITHOUT PRIOR NOTICE.  I UNDERSTAND THAT NO REPRESENTATIVE OF THE EMPLOYER HAS THE AUTHORITY TO MAKE ANY ASSURANCES TO THE CONTRARY.

Signature*

Date*

Resume Upload

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