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Employment
APPLICATION FOR EMPLOYMENT
Our policy is 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 disability, or veteran status.
Date
*
MM slash DD slash YYYY
Date of Birth
*
MM slash DD slash YYYY
Email
First Name
*
Middle Name
*
Last Name
*
Street Address
*
City
*
State
*
ZIP Code
*
Telephone
*
Social Security #
*
Position Desired
How did you hear of this position?
When can you start?
*
MM slash DD slash YYYY
Desired Wage
Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.)
*
Yes
No
Are you looking for full-time employment?
*
Yes
No
What hours are you available?
Are you willing to work swing shift?
Yes
No
Are you willing to work graveyard shift?
Yes
No
Have you ever been convicted of a felony? (This will not necessarily affect your application.)
Yes
No
Please describe conditions.
Education
High School
School Name / Location
Year
Major
Degree
Collage
Collage Name / Location
Collage Year
Collage Major
Collage Degree
Collage
Collage Name / Location
Collage Year
Collage Major
Collage Degree
Post-College
Post-Collage Name / Location
Post-Collage Year
Post-Collage Major
Post-Collage Degree
Other Training
Other Training Name / Location
Other Training Year
Other Training Major
Other Training Degree
In addition to your work history, are there other skills, qualifications, or experience that we should consider?
EMPLOYMENT HISTORY - START WITH MOST RECENT EMPLOYER
Job #1
Company Name
Address
Telephone
Date Started
MM slash DD slash YYYY
Starting Wage
Starting Position
Date Ended
MM slash DD slash YYYY
Ending Wage
Ending Position
Name of Supervisor
May we contact?
Yes
No
Responsibilities
Reason for Leaving
Job #2
Company Name
Address
Telephone
Date Started
MM slash DD slash YYYY
Starting Wage
Starting Position
Date Ended
MM slash DD slash YYYY
Ending Wage
Ending Position
Name of Supervisor
May we contact?
Yes
No
Responsibilities
Reason for Leaving
Job #3
Company Name
Address
Telephone
Date Started
MM slash DD slash YYYY
Starting Wage
Starting Position
Date Ended
MM slash DD slash YYYY
Ending Wage
Ending Position
Name of Supervisor
May we contact?
Yes
No
Responsibilities
Reason for Leaving
Job #4
Company Name
Address
Telephone
Date Started
MM slash DD slash YYYY
Starting Wage
Starting Position
Date Ended
MM slash DD slash YYYY
Ending Wage
Ending Position
Name of Supervisor
May we contact?
Yes
No
Responsibilities
Reason for Leaving
ACKNOWLEDGEMENT
Terms and conditions
*
By checking this box, 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 is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing.
Signature
*
Date
*
MM slash DD slash YYYY
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