Application For Employment

      Prospective employees will receive consideration without discrimination based on race, creed, color, sex, age, national origin, handicap, veteran status or any condition prescribed by state or local law.

Personal Information:
Last Name: First Name: Middle Name:
Home Phone: Business Phone: SSN:
Address:
City:   State:   Zip:
Email:

Employment Questions:
Desired Position: Location: Pay Expected:
Apart from absence for religious observance, are you available for full-time work? Yes   No
If not, what hours can you work?
Will you work overtime if asked? Yes   No
When are you available to start?
Have you ever applied for employment with us? Yes   No
If yes, when?
and where?
Job related training/skills:
(languages, machine operation, etc.)

Legal Standing:
Are you legally eligible for employment in the United States? Yes   No
Have you been convicted of any crimes in the past ten years, excluding misdemeanors and summary offenses, which have not been annulled, expunged, or sealed by a court? Yes   No
If Yes, please describe in full:

Education:
Study Level School Name/Location Course of Study Years
Completed
Did You
  Graduate?
Degree/Diploma
Graduate Yes
No 
College Yes
No 
Business/
Trade/Tech
Yes
No 
High School Yes
No 
Elementary Yes
No 

Employment History:
Company Name: Employed From: to:
Address: Weekly Pay: Start: Last:
Supervisor's Name: Job Title:
Phone Number: Work Performed:
Reason for leaving:
Company Name: Employed From: to:
Address: Weekly Pay: Start: Last:
Supervisor's Name: Job Title:
Phone Number: Work Performed:
Reason for leaving:
Company Name: Employed From: to:
Address: Weekly Pay: Start: Last:
Supervisor's Name: Job Title:
Phone Number: Work Performed:
Reason for leaving:
Company Name: Employed From: to:
Address: Weekly Pay: Start: Last:
Supervisor's Name: Job Title:
Phone Number: Work Performed:
Reason for leaving:
We may contact the employers listed above unless you indicate those you do not want us to contact.
Do not contact: Reason:

Military:
Did you serve in the U.S. Armed Forces?   Yes No    If yes, which branch?
Describe any training received relevant to the position for which you are applying:

Additional Information: (Membership in profession and civic organizations, special accomplishments, awards, etc.)

Applicant's Signature:

Please read and understand this statement before typing your signature:

        The information I have provided in this Application for Employment is true, correct and complete. False, incomplete or misrepresented information of any kind, will be sufficient cause for my application to be rejected or, if discovered after I am employed, cause for immediate termination of my employment.

        I authorize the employer to contact and obtain information about me from previous employers, educational institutions and "references" I provided, and any other party necessary to verify the accuracy of information I disclosed in this application, a related employment resume or a personal interview. To assist in the processing of my Application, I waive all rights and claims I may otherwise have against the employer or its representatives, for seeking, and using information to evaluate my employment request and all other persons, corporations or organizations who provide information for this purpose.

        This application will expire in 30 days. After that date, unless otherwise notified, I understand that my status as an applicant will end. I may re-apply for employment in the future by completing a new application.

        This application is not an employment agreement. If I accept an offer of employment I understand the employer may terminate my employment at any time, with or without cause and without prior notice, unless required by law. I understand that no one, other than an executive officer of the employer, has authority to enter into any employment agreement with terms contrary to the foregoing and then only in writing signed by such officer.

I fully understand and accept all terms and conditions in the above statement.

Date: September 27, 2016     Electronic Signature:



or