Employment Application
Position Applied For:
General Employment
Maintenance
Management
Referral Source:
Your Full Name:
E-mail Address:
Mailing Address:
May we contact you at work?:
Contact Phone:
Best Time to Call Contact Phone:
Have you ever Applied here before?:
If Yes, Give Date:
If you are under 18, can you furnish a work permit?.................................... Yes:
Have you ever been employed here before?:
If Yes, please give dates:
Are you legally eligible for employment in the US?....................................... Yes:(proof of U.S. citizenship or Immigration status will be require upon employment)
Date Availible for work:
Type of employment:
Full Time
Part Time
Temporary
Seasonal
Educational Co-Op
Are you on a lay-off and subject to recall?..................................................... Yes:
Will you relocate if the job requires it?........................................................... Yes:
Will you travel if the job requires it?............................................................... Yes:
Will you work overtime if the job requires it?................................................. Yes:
If required by the employer, will you undergo a pre-employment physical?.. Yes:
Have you ever been bonded?........................................................................... Yes:
Have you ever been convicted of a felony in the last seven(7) years?............. Yes:(Such conviction may be relevant if job related, but does not bar you from employment)
If yes explain::
Drivers License Number..........................................................
Employment History?: (start-end dates,employer,address,job title, superviser,reason for leaving, start-end salery)
Comments: (including explaination of any gaps in employment)
Skills and qualifications: summarize special skills and qualifications acquired from employment or other experience that may qualify you for work with our company
Educational History: A. List the last three (3) schools attended, starting with the last one. B List the number of years completed. C. Indicate degree or diploma earned if any. D. Grade point average or class rank. E. Major and minor field of study (if applicable)
References: List name and phone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three (3) school or personal references who are not related to you.
List professional, trade, business or civic associations and any offices held. (Exclude information which would reveal sex, race, religion, national, origin, age ancestry or other protected status.)
List special accomplishments, publications, awards. (Exclude information which would reveal sex, race, religion, national, origin, age ancestry or other protected status.)
List any additional information you would like us to consider.
It is understood and agreed 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. Furthermore, 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.
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 excluding any applicant's consideration for employment on a basis prohibited by local , state or federal law.
This application will be valid for (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 for me to fill out a new application.
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