Application for Employment

Failure to complete all sections of this application may disqualify an applicant from consideration. This application will remain on file for one year and active for one month. Applicants are considered on the basis of qualifications without regard to race, color, religion, sex, national origin, age, marital status, veteran status, disability or sexual orientation.

PERSONAL INFORMATION


Name:* *
(Last) (First) (Middle) (Email)



Address:

City: State: Zip:

Phone number Cell number
Are you 18 years old or older?
Are you 21 years old or older?

Are you legally authorized to work in the U.S.?

EMPLOYMENT DESIRED


Position: Date you can start:

Are you currently employed? May we inquire of your present employer?

Salary Desired: Applying for:

Have you applied or worked for this company? No
If yes, when and what position?

EDUCATION, EXPERIENCE AND SKILLS


Highest grade completed in High School: Diploma: GED:

Name of High School: City: State:

Number of years attended at Trade School: Junior College: College: Other:
College(s) and City/States:

List any degrees received:



List professional, trade, business or civil activities and any offices held (you may exclude organizations which would indicate
the race, sex, age, marital status, color, national origin or ability of its members.)

List any skills or hobbies which may be relevant to the qualification necessary for this position.

Have you ever been discharged, fired or asked to resign from any employment?
If yes, explain.

FORMER EMPLOYERS - List below the last three employers, starting with the most recent


Employer 1 Employer's Name:

Phone:

Start Date: End Date:

Position: Pay Rate:

Reason for Leaving:


Duties:


Employer 2 Employer's Name:

Phone:

Start Date: End Date:

Position: Pay Rate:

Reason for Leaving:


Duties:



Employer 3 Employer's Name:

Phone:

Start Date: End Date:

Position: Pay Rate:

Reason for Leaving:


Duties:

Have you ever been convicted of a crime?

If yes, what was the nature of the offence, when, where, and the outcome?

(a conviction record will not necessarily be a bar to employment).

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that,
if employed, falsified statements on this application or in an interview, including, but not limited to failure to reveal prior employers,
shall be grounds for immediate dismissal.

I authorize investigation of all statements contained herein and the references listed above to give you any and all information
concerning my previous employment and any pertinent information they may have, and release all parties from all liability for any
damage that may result from furnishing same to you.

I understand and agree that, if hired, my employment is “at-will”, for no definite period and may, regardless of the date of payment
of my wages and salary, be terminated at any time with or without prior notice and without cause”.