Application For Employment

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.We are an equal opportunity employer.

Date of Application:
Position(s) Applied For:
Salary Desired (be specific):

Contact Information

Last Name:
First Name:
Middle Name:
Street:
City:
State:
Zip Code:
Telephone:
Email Address

Drivers License #:
State of Issue:
Class:
Expiration Date:
Have you had any accidents during the past three years?
How Many?
Have you had any moving violations during the past three years?
How Many?

Best time to contact you at home is:
Are you currently employed?
May we contact your present employer?
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment.
Date available for work (mm/dd/yyyy):
What is your desired salary range?
Are you currently on "lay-off" status and subject to recall?
Can you travel if the job requires it?

Days/hours available to work? Do you hacve a preferrence? Is so, please state below:

Mon:
Tue:
Wed:
Thur:
Fri
Sat:
Sun:
 
How many hours can you work weekly?
Can you work nights?

Education

     
-School Name and
Address of School
Course of Study Years Completed Diploma/Degree
-High School
-Undergraduate
-College
-Graduate/
-Professional
-Other(Specify)

Work Experience

     

Start with your present or last job. Include any job-related military service or assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer Dates Employed Work Performed
Address From To
Telephone
Starting/Present
Job Title
Hourly Rate/Salary
Supervisor Starting Final
Reason for leaving
May we contact?

Employer Dates Employed Work Performed
Address From To
Telephone
Starting/Present
Job Title
Hourly Rate/Salary
Supervisor Starting Final
Reason for leaving
May we contact?

Employer Dates Employed Work Performed
Address From To
Telephone
Starting/Present
Job Title
Hourly Rate/Salary
Supervisor Starting Final
Reason for leaving
May we contact?

Describe any specialized training, apprenticeship, skills or equipment operated. Please list training, certifications (with dates), skills and experience specific to the work you are appying for:


Military
Have you ever been in the armed forces?
If so, which branch:
Are you now a member of the National Guard or Reserves?
Specialty: Date Entered: Discharge Date:
Were you Honorably Discharged from Military Service?
If you answered No please state Discharge status and reason:

Have you ever been convicted of a crime?
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation:

Personal/Professional References Do not include family members or past supervisors.
Name Phone Number Best Time to Call Occupation
1.
2.
3.

Applicant’s Statement

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.