Application for Employment

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

Applications are received and employees are hired without regard to race, creed, color, sex, religion, age, nation origin, marital status, physical or mental handicap, disability, sexual orientation, veteran’s status, citizenship status, or any other protected classes under state, local, or country regulations. The receipt of this application does not mean that job openings exist and does not obligate us in any way. We appreciate your interest in our organization.

THIS IS A DRUG-FREE WORKPLACE

* denotes a required field
PERSONAL INFORMATION
First Name* Last Name*
Address* Address 2
City* State*
Zip code* Email*
Home Phone* Cell Phone
POSITION/AVAILABILITY
Position Applied For*
Salary expectation
Are you available for work* Full-timePart-timeWeekendsTemporary
Days Available* MondayTuesdayWednesdayThursdayFridaySaturdaySundayAny
Hours Available* AMPMGraveyard
For specific Day/Hour availability, please enter information below.
What date are you available to start work?*
How were you referred to us?
Have you filed an application here before?* YesNo
If yes, date/location
Have you ever been employed here before?* YesNo
If yes, date/location
Are you employed now?* YesNo
May we contact your employer?* YesNo
Does your present employer know of your plans to change employment?* YesNo
Why do you desire to make a change?
Are you on a lay off and subject to recall?* YesNo
Have you ever been discharged or requested to resign from a position?* YesNo
If yes, please explain.
How much time have you lost from work during the last 12 months?*
Do you have steady transportation to work?* YesNo
Can you travel if a job requires it?* YesNo
Have you ever held a position of trust?
(handling money or confidential material?)*
YesNo
Have you ever been refused bond?* YesNo
If yes, please explain:
Are you eligible to work in the United States?*
(Proof of citizenship/immigration status is required upon employment.)
YesNo
Have you ever been convicted of or received a sentence for a crime(s)
other than a minor traffic violation?*
(Answering "Yes" is not an automatic bar to employment)
YesNo
If so, state date, court and place where offense(s) occurred.
Do you hold a valid driver's license?* YesNo
List State*
Have you been convicted of any moving violations in the last 3 years?* YesNo
If Yes, give date(s) and explanation
List three things that are important to you in a work environment.


List three characteristics that best describe you.


Please provide us with a minimum of TWO references:
Reference 1 * Name*:
  Email*:
  Telephone:
  Type*: ProfessionalPersonal
Reference 2 * Name*:
  Email*:
  Telephone:
  Type*: ProfessionalPersonal
Reference 3 Name:
  Email:
  Telephone:
  Type: ProfessionalPersonal
Reference 4 Name:
  Email:
  Telephone:
  Type*: ProfessionalPersonal
EMPLOYMENT HISTORY
Present Or Last Position Previous Position
Employer:* Employer:
Address: (Street, City and State)* Address: (Street, City and State)
Job Title:* Job Title:
Supervisor:* Supervisor
Phone Number*
###-###-####
Phone Number
###-###-####
Email: Email:
Summary of Work Performed & Job Responsibilities:* Summary of Work Performed & Job Responsibilities:
Start Date*
MM/DD/YYYY
Start Date
MM/DD/YYYY
End Date*
MM/DD/YYYY
End Date
MM/DD/YYYY
Hourly Rate/Salary* Hourly Rate/Salary
Reason for Leaving:* Reason for Leaving:
Previous Position Previous Position
Employer: Employer:
Address: (Street, City and State) Address: (Street, City and State)
Job Title: Job Title:
Supervisor Supervisor
Phone Number
###-###-####
Phone Number
###-###-####
Email: Email:
Summary of Work Performed & Job Responsibilities: Summary of Work Performed & Job Responsibilities:
Start Date
MM/DD/YYYY
Start Date
MM/DD/YYYY
End Date
MM/DD/YYYY
End Date
MM/DD/YYYY
Hourly Rate/Salary Hourly Rate/Salary
Reason for Leaving: Reason for Leaving:
SPECIAL SKILLS AND QUALIFICATIONS:
Summarize special skills and qualifications acquired from employment or other experience: List professional, trade, business or civic activities and offices held:
Computer skills
(list programs, mobile devices, and proficiency level)
What foreign languages do you speak, read , and/or write?
Typing (WPM) Shorthand (WPM)
EDUCATION INFORMATION
Name and Location Of School -Years Completed- Degree/Diploma*
Did you Graduate?* YesNo
Name and Location Of School -Years Completed- Degree/Diploma
Did you Graduate? YesNo
Name and Location Of School -Years Completed- Degree/Diploma
Did you Graduate? YesNo
Name and Location Of School -Years Completed- Degree/Diploma
Did you Graduate? YesNo
Honors recieved:
MILITARY SERVICE
Branch of Service and Serial Number List Duties/Special Training
Rank at Discharge
Present Selective Service Classification
AGREEMENT

The facts set forth above in my application for employment are true and complete. I understand that false statements or omission of information on this application or any other employment form may lead to dismissal or denial of employment. You are hereby authorized to make any investigation of my personal history, financial, criminal, credit and motor vehicle records through any investigative or credit agencies or bureaus of your choice. You are also authorized to administer personality profile tests and verify my background. A criminal record or sentence is not an automatic disqualification for employment. I agree to submit to any drug or alcohol testing prior to or after employment and I agree to submit to a medical evaluation, if required.

In making this application for employment, I also understand that an investigative consumedr report may be made whereby information is obtained through personal interviews with my neighbors, friends or others with whom I am acquainted. This inquiry includes information as to my character, general requtation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of this investigative consumer report. In exchange for the consideration of my employment application by this company, I hereby release and forever discharge the company (including its directors, officers, employees and agents) and my past and/or present employers (their directors, officers, employees and agents) from any liabilities which may result from an investigation of my past and/or present employment or from the disclosure of such information. I authorize the use of any information in this application to verify my statements, and I authorize the past employers, doctors, all references and any other persons to answer all questions asked concerning my ability, character, reputation and previous employment record.

I understand that if my application is accepted that employment with this company at all times is employment "at will." It is further understood that this "at will" relationship may not be changed by any written document, verbal statements, or by conduct unless such change is specifically acknowledged by an authorized executive of the company. I further understand that my "at will" employment may be terminated at any time by myself or the company and includes no guarantee, contract or promise of employment for any specific length of time. I understand that the first ninety (90) days of employment is a new hire introductory period.

Do you agree with the agreement?* Yes I agree.
Name*     Today's Date*
In case of emergency, I authorize you to notify:
Work Phone:
Home Phone:
Verififcation code: captcha