Application For Employment

APPLICATION FOR EMPLOYMENT

 

It is our policy to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental handicap, or veteran status.

Name: Last __________ First __________ Middle _________ Date __________

Street Address ______________________________________________________

City ______________________ State ____________ Zip _________________

Telephone ( ) ________________ Social Security # ____________________

Position applied for ___________________________________________________

How did you hear of this opening ________________________________________

When can you start _____________________ Desired Wage $ ______________

Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis?

 [ ] Yes [ ] No

Are you looking for full time employment? [ ] Yes [ ] No

If no, what hours are you available? _______________

Are you willing to work swing shift? [ ] Yes [ ] No

Are you willing to work graveyard? [ ] Yes [ ] No

Have you ever been convicted of a felony? [ ] Yes [ ] No

If yes, please fully describe the circumstances: _________________________________________ _____________________________________________________

Education: School Name and Location Year Major Degree

High School _____________________________________________________

College _____________________________________________________

College _____________________________________________________

Other _____________________________________________________

_____________________________________________________

In addition to your work history, are there are other skills, qualifications, or experience we should consider:

_____________________________________________________ _____________________________________________________

Employment History: (Start with most recent employer.)

Company name _______________________

Address __________________________________ Telephone _________________

Date Started _______ Starting Wage _______ Starting Position ___________

Date Ended ________ Ending Wage _______ Ending Position ___________

Name of Supervisor ________________ May we contact? [ ] Yes [ ] No

Responsibilities _____________________________________________________

Reason for leaving _____________________________________________________

Company name _______________________

Address __________________________________ Telephone _________________

Date Started _______ Starting Wage _______ Starting Position ___________

Date Ended ________ Ending Wage _______ Ending Position ___________

Name of Supervisor ________________ May we contact? [ ] Yes [ ] No

Responsibilities ________________________________________________________

Reason for leaving ______________________________________________________

Company name _______________________

Address __________________________________ Telephone _________________

Date Started _______ Starting Wage _______ Starting Position ___________

Date Ended ________ Ending Wage _______ Ending Position ___________

Name of Supervisor ________________ May we contact? [ ] Yes [ ] No

Responsibilities _____________________________________________________

Reason for leaving _____________________________________________________

Attach additional information if necessary.

I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history. I understand that employment at this company is "at will," which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment will continue on that basis. I understand that no supervisor, manager, or executive of this company, other than the president has the authority to alter the foregoing.

Signature _________________________ Date ____________________

 

 

Warning:

These forms are provided AS IS. They may not be any good. Even if they are good in one jurisdiction, they may not work in another. And the facts of your situation may make these forms inappropriate for you. They are for informational purposes only, and you should consult an attorney before using them.

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