Application for Employment

We consider applications for all positions without regard to race, color, religion, creed, sex, national origin, disability, sexual orientation, citizenship status or any other legally protected status.

 PERSONAL INFORMATION

 

 

Date of Application*:

First Name*:

M.I.:

Last Name*:

Street Address:

Apartment/Unit:

City:

State:

Zip:

Home Phone*:

Cell Phone:

Best Time to contact you at home is:

Email*:

Social Security Number (Voluntary):

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

Yes

No

Are you a US citizen?*

Yes

No

If no, are you authorized to
work in the US?

Yes

No

Proof of citizenship or immigration status will be required upon employment

Have you ever worked for this Company?*

Yes

No

If so, when?

Are you available to work:

Full Time

Please indicate 1 2 3 shift

Part Time

Please indicate Morning, Afteroon or Evenings

Temporary

Dates Available

 EMPLOYMENT DESIRED

Position:

Salary desired:

Do any of your friends or relatives,
other then spouse, work here?

Yes

No

Are you employed?

Yes

No

If so, may we inquire of your employer?

Yes

No

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

Yes

No

Can you travel if a job requires it?

Yes

No

When can you start?

How did you hear about us?

 EDUCATION

Name and Location

Years Attended

Date Graduated

Subjects

Elementary School:


Name and Location

Years Attended

Date Graduated

Subjects

High School:


Name and Location

Years Attended

Date Graduated

Subjects

College:


Name and Location

Years Attended

Date Graduated

Subjects

Graduate School:


Name and Location

Years Attended

Date Graduated

Subjects

Trade/ Other:

 DESCRIBE ANY SPECIAL TRAINING OR SKILLS:

 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:

 OTHER QUALIFICATIONS:

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

 SPECIALIZED SKILLS (CHECK SKILLS/EQUIPMENT OPERATED)

Terminal  Spreadsheet  PC/MAC   WordProcessing
Typewriter  Shorthand

Production/Mobile Machinery (list)
  
Other (list)
  
State any additional information you feel may
be helpful to us in considering your application
  

 EMPLOYMENT HISTORY

Start with your most recent employer:

Dates
Employed

Name and Phone #

Position

Responsibilities

Salary

Reason
For Leaving

From

To

If so, may we contact your previous supervisor as a reference?

Yes No

 REFERENCES

List persons, not related to you, whom you have known at least one year.

Name

Address

Business

Years Known

1.

2.

3.

 MILITARY SERVICE

Branch:

From To
 

Rank of Discharge:

Type of Discharge

If other than honorable, explain

 PHYSICAL LIMITATIONS

 

In case of emergency, notify:

Name:

Relationship:

Phone #:


Have you ever been convicted of a felony or misdemeanor in the last 5 years?

 

Yes

No

If yes, explain:

A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question.

 

 Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation?

 

Yes

No


 

APPLICANT'S STATEMENT

I certify that answers given herein are true and complete.

I authorize 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.

 

Signature of Applicant:
(type your full name)

Date:

 

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