We are an equal opportunity and do not unlawfully discriminate in employment. No questions on this application are used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment services and programs is available to all persons..
| Name | |
| Street Address | |
| Address (cont.) | |
| City | |
| State/Province | |
| Zip/Postal Code | |
| Country | |
| Work Phone | |
| Home Phone | |
| FAX | |
Type of employment desired:
Enter the date you are available to start work : -- mm/dd/yy
Are you able to meet the attendance requirements? Yes No
Can you travel if required by this position? Yes No
Can you submit proof of legal employment authorization and identity? Yes No
If you area under 18, can you furnish a work permit if it is required? Yes No
Have you ever been convicted of a crime in the last 7 years? Yes No
If Yes, please explain:
How were you referred to us
Driver's license number (if driving is an essential job duty)
Employment History
Employer: Position held:
Address: Phone Number:
Immediate supervisor and title:
Dates employed from to Salary:
Reason for leaving:
______________________________________________________________________________________________
Employer: Position held:
Address: Phone Number:
Immediate supervisor and title:
Dates employed from to Salary:
Reason for leaving:
______________________________________________________________________________________________
Employer: Position held:
Address: Phone Number:
Immediate supervisor and title:
Dates employed from to Salary:
Reason for leaving:
______________________________________________________________________________________________
Other Skills and Qualifications
Educational History
List school name and location, year completed, course of study, and any degrees earned:
High School:
College:
Technical Training:
Other:
References:
List three references names, telephone numbers, and years known (do not include relatives)
By submitting form, I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representative for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.
I understand that all misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.
If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is not violation of applicable federal or state law.
I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.
I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.