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Employment Application

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 years.
Personal Information
First Name:
Middle Name:
Last Name:
Home Phone:
Work Phone:
Cell Phone:
Email Address:
Current Address
Street:
City:
State:
Zip Code:
Since (Mo/Yr):
Prior Address (1)
Street:
City:
State:
Zip Code:
Since (Mo/Yr):
To (Mo/Yr):
Prior Address (2)
Street:
City:
State:
Zip Code:
Since (Mo/Yr):
To (Mo/Yr):
High School
School:
City:
State:
Diploma:
Undergrad School
School:
City:
State:
Diploma:
Deg/Cert/Dip:
Area of Study:
Grad School
School:
City:
State
Diploma:
Deg/Cert/Dip:
Area of Study:
Other School
School:
City:
State:
Diploma:
Deg/Cert/Dip:
Employment Information
Position Applied For:
Date You Can Start:
Desired Salary ($):
Do You Prefer:
Can you work:
 
Weekends
 
Evenings
Available:
 
M
 
Tu
 
W
 
Th
 
F
 
Sa
 
Su
Not Available:
Please answer all of the following questions.
1.
Are you at least 18 years of age and legally eligible to work for our company in the United States?
2.
Have you worked for this business before?
 
If yes, please provide dates and locations.
 
3.
Have you received a description of the job or been made aware of the essential functions of the job for which you are applying?
4.
Do you understand the job requirements?
 
If no, please explain.
 
5.
Are you on layoff and subject to recall?
6.
Are you currently bound by a noncompetition, confidentiality or trade secret agreement?
 
If yes, please explain...
 
7.
Have you ever been discharged or asked to resign from a job?
 
If yes, please explain...
 
8.
Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?
 
If yes, please explain...
 
Employer
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Prior Employer (1)
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Prior Employer (2)
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Prior Employer (3)
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Job-related Skills
4.
Please list all states from which you hold or held a driver's license:
 
Reference (1)
Name:
Address:
Telephone:
Relationship:
Years Acquainted:
Reference (2)
Name:
Address:
Telephone:
Relationship:
Years Acquainted:
Reference (3)
Name:
Address:
Telephone:
Relationship:
Years Acquainted:
Reference (4)
Name:
Address:
Telephone:
Relationship:
Years Acquainted:
Resume (Text Version)
 
Copy and Paste a text version of your resume here.
 
Upload File
 
Attach a file to your application submission
 
Applicant's Certification Agreement
1.
I authorize the investigation of all statements contained in this application and release from all liability any persons or employers supplying such information, and I also release the company from all liability that might result from making the investigation.
2.
I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or on any required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.
3.
I agree, if I am offered and accept a position, to conform to all existing and future Company rules and regulations and I understand that the Company reserves the right to change wages, hours and working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE AT-WILL, MEANING THAT EITHER PARTY CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.
4.
I understand that any employment offer is contingent upon my providing, within three (3) working days of employment, valid proof od identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986.
5.
I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.
6.
I understand that by typing my name in the signature box below and submitting this application electronically, this becomes a legal and binding contract.
Signature
 
Type Name in Signature Box:
 
 
Today's Date: 2010-09-08 03:11:52 CDT
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