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Application For Employment

ALL POTENTIAL EMPLOYEES ARE EVALUATED WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, MARITAL OR VETERAN STATUS, THE PRESENCE OF A NON-JOB RELATED HANDICAP OR ANY OTHER LEGALLY PROTECTED STATUS.

Position Sought
How did you learn about the position?
Name
Address
City
State
Zip
Home Phone
Office Phone
Email Address

On what date would you be available for work?

Desired Wage/Salary

Are you a U.S. citizen, or are you otherwise authorized to work in the U.S. without any restriction?

Yes No

Have you ever been convicted of a felony?

Yes No

If yes, please describe circumstances

Have you ever been involuntarily terminated or asked to resign from any position of employment?

Yes No

If yes, please describe circumstances

If selected for employment, are you willing to submit to a pre-employment drug screening test?

Yes No

EDUCATION

School Name Location Yrs Attended Degree Major

Other training, certifications, or licenses held

List other information pertinent to the employment you are seeking

EMPLOYMENT (Most Recent First)

1. Employer
Job Title
Dates Employed
Prior Position Held within Company
(if any)
Address
City
State
Zip
Phone
Supervisor
May we contact?
Yes No
Starting Salary
Ending Salary
Duties Performed
Reason for Leaving
2. Employer
Job Title
Dates Employed
Prior Position Held within Company
(if any)
Address
City
State
Zip
Phone
Supervisor
May we contact?
Yes No
Starting Salary
Ending Salary
Duties Performed
Reason for Leaving
3. Employer
Job Title
Dates Employed
Prior Position Held within Company
(if any)
Address
City
State
Zip
Phone
Supervisor
May we contact?
Yes No
Starting Salary
Ending Salary
Duties Performed
Reason for Leaving

ACKNOWLEDGMENT AND AUTHORIZATION

I certify that answers given herein are true and complete to the best of my knowledge.

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.

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