APPLICATION OF EMPLOYMENT
It is the policy if this company to provide equal employment opportunities to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, physical or mental handicap or veteran status.
NOTE: Please type or print your answers. If you print, please do so in blue or black ink and write neatly. An illegible application may preclude you from consideration.
POSITION APPLYING FOR: _________________________________________________________
Personal Information
______________________________________________________________________________
First Name Middle Initial Last Name
Current Address:
______________________________________________________________________________
Street and Apt. # City State Zip Code
Permanent Address (if different from above):
______________________________________________________________________________
Street and Apt. # City State Zip Code
Telephone:______________________ E- mail:___________________________
Social Security #: ______-______-______ Drivers License #: _______________State:______
I am a U.S. Citizen or otherwise authorized to work in the United States on and unrestricted basis:
YES NO
If applicable, please list your visa type, visa # and expiration: ____________________________
_____________________________________________________________________________
Have you ever been convicted of a felony? YES NO
If you answered yes, please explain:
_____________________________________________________________________________
Have you ever served in the U.S. Military? YES NO
If yes, please provide the following information:
Branch of Service:________________________ Rank at time of separation:_________________
I Served form ________________________ to _________________________.
Special Honors: _________________________________________________________________
|
|
|
EMPLOYMENT HISTORY |
|
Present or Most Recent Employer
Employer: _____________________________ Address: __________________________
Your Position: _________________________ Salary: ____________________________
Duties: _________________________________________________________________
Dates of Employment: _____________________ to ______________________
Supervisor: ___________________ ____________________ May we contact? YES NO Name Title
Reasons for leaving: ___________________________________________________________________________
|
|
Prior Employer |
|
Employer: _____________________________ Address: __________________________
Your Position: _________________________ Salary: ____________________________
Duties: _________________________________________________________________
Dates of Employment: _____________________ to ______________________
Supervisor: ___________________ ____________________ May we contact? YES NO Name Title
Reasons for leaving: ___________________________________________________________________________
|
|
Prior Employer |
|
Employer: _____________________________ Address: __________________________
Your Position: _________________________ Salary: ____________________________
Duties: _________________________________________________________________
Dates of Employment: _____________________ to ______________________
Supervisor: ___________________ ____________________ May we contact? YES NO Name Title
Reasons for leaving: ___________________________________________________________________________
|
|
Education |
High School
|
_______________________________________________________________________________ Name and Address
Did you graduate? YES NO Attended from ____________to _____________
If you did not graduate, did you receive your GED? YES NO
Special honors or awards: ______________________________________________________ |
|
Technical or Vocational School |
|
________________________________________________________________________________ Name and Address
Did you graduate? YES NO Attended from _____________to ______________
Degree or Certification: __________________________ Specialty: _________________________
Special Honors or awards: _________________________________________________________ |
|
College or University |
|
________________________________________________________________________________ Name and Address
Did you graduate? YES NO Attended from _____________to ______________
Degree or Certification: __________________________ Specialty: _________________________
Special Honors or awards: _________________________________________________________
|
|
Other |
|
________________________________________________________________________________ Name and Address
Did you graduate? YES NO Attended from _____________to ______________
Degree or Certification: __________________________ Specialty: _________________________
Special Honors or awards: _________________________________________________________
|
|
|
References
Please List three references other than relatives:
Name ________________________________________________________________________
Address _______________________________________________________________________
Phone # _______________________________________________________________________
Occupation ____________________________________________________________________
Years Acquainted _______________________________________________________________
Name ________________________________________________________________________
Address _______________________________________________________________________
Phone # _______________________________________________________________________
Occupation ____________________________________________________________________
Years Acquainted _______________________________________________________________
Name ________________________________________________________________________
Address _______________________________________________________________________
Phone # _______________________________________________________________________
Occupation ____________________________________________________________________
Years Acquainted _______________________________________________________________
Position Information
Position Specifications
Position Applying For: ____________________________________________________
How did you hear about this job? ___________________________________________
What hours are you willing to work?_________________________________________
Would you be able to work weekends? YES NO
Are you willing to travel for the job? YES NO
When would you be able to start? __________________________________________
Desired salary? ____________________ per ___________________
Skills
Please describe any skills you have in the following areas:
Computer:
_____________________________________________________________________________
_____________________________________________________________________________
Languages Spoken (other than English):
_____________________________________________________________________________
Other:
______________________________________________________________________________
______________________________________________________________________________
I hereby certify that my answers and assertions set forth on this application are true and complete to the best of my knowledge. If I am employed, I understand that any false statements on this application shall considered sufficient cause for my dismissal. I hereby authorize this company to investigate any aspect of my prior education and employment history. Furthermore I understand that if I am hired, employment with this company is “at will,” which means that either the company or I can terminate my employment for any reason not prohibited by state or federal law. Signature:__________________________________ Date ________________________
