Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, handicap or veteran status.
Last Name First Name Middle Name Email Date Street Address City, State, Zip Home Telephone Business Telephone Social Security # Have you ever applied for employment with us or worked for us? yesno If yes: Month and Year Position Desired Pay Expected Apart from absence for religious observance, are you available for full time work? yesno If not, what hours can you work? Will you work overtime if asked? yesno Are you legally eligible for employment in the United States? yesno When will you be available to begin work? Other special training or skills (Language, machine operation, military service, etc.)
School GraduateCollegeBusiness/Trade/TechnicalHigh SchoolElementary Name and Location of School Course of Study No. of Years Completed Degree or Diploma? degreediploma Have you in the last 7 years been convicted of a felony? yesno If yes, please describe in full
Please give accurate, complete full-time and part-time employment record. Start with your present or most recent employer.
First Company Name Telephone Address Employed - (State month and year) From: Employed - (State month and year) To: Name of Supervisor Weekly Pay Start: Weekly Pay Last: State Job Title and Describe your Work Reason for leaving
Second Company Name Telephone Address Employed - (State month and year) From: Employed - (State month and year) To: Name of Supervisor Weekly Pay Start: Weekly Pay Last: State Job Title and Describe your Work Reason for leaving
Third Company Name Telephone Address Employed - (State month and year) From: Employed - (State month and year) To: Name of Supervisor Weekly Pay Start: Weekly Pay Last: State Job Title and Describe your Work Reason for leaving
REFERENCES: GIVE NAME AND TELEPHONE NUMBER OF THREE REFERENCES WHO ARE NOT RELATED TO YOU AND ARE NOT PREVIOUS EMPLOYERS.
First: Second: Third:
The information provided in the Application for Employment is true, correct and complete. If employed, any misstatement or admission of fact on this application may result in dismissal. I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future. If you decide to engage an investigative consumer reporting agency to report on my credit and personal history, I authorize you to do so. If a report is obtained you must provide, at my request, the name of the agency so I may obtain from them the nature and substance of the information contained in the report.
Do you agree with the previous statement? yesno
