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APPLICATION FOR EMPLOYMENT

Position(s) Applied for:
Date of Application
LAST
FIRST
MIDDLE
STREET
CITY
STATE
ZIP
Telephone:
SSN:

Have you ever been employed here before?
  Yes   No

Are you legally eligible for employment in this country?
(Proof of U.S. citizenship or immigration status will be required upon employment.)
  Yes   No

Date available for work:

Type of employment desired:
  Full-time   Part-time   Temporary

Are you able to meet the attendance requirements of the position?:
  Yes   No

Have you been convicted of a felony in the last seven (7) years?
  Yes   No

(Such conviction may be relevant if job related, but does not bar you from employment.)
If yes, please explain:

Drivers License number (if required by job):
State:

SKILLS AND QUALIFICATIONS

Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work with our company.

EMPLOYMENT HISTORY

List your three (3) employers, assignments or volunteer activities, starting with the most recent, including military experience.
From
To
Employer
Telephone

Job Title
Address

Immediate Supervisor and Title
Summarize the nature of work performed and job responsibilities

Reason for leaving
Hourly Rate/Salary
Start $
per
Final $
per


From
To
Employer
Telephone

Job Title
Address

Immediate Supervisor and Title
Summarize the nature of work performed and job responsibilities

Reason for leaving
Hourly Rate/Salary
Start $
per
Final $
per


From
To
Employer
Telephone

Job Title
Address

Immediate Supervisor and Title
Summarize the nature of work performed and job responsibilities

Reason for leaving
Hourly Rate/Salary
Start $
per
Final $
per


EDUCATION BACKGROUND

High School

Name and Location
Years Complete
Did You Graduate
  Yes
  No
Course of Study

College

Name and Location
Years Complete
Did You Graduate
  Yes
  No
Course of Study
Major
Degree

Other

Name and Location
Years Complete
Did You Graduate
  Yes
  No
Course of Study

REFERENCES

Name
Telephone
Years Known




It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the Employer's service if I have been employed.

I give the Employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Employer and its representatives for seeking such information an all other persons, corporations, or organizations for furnishing such information.
The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state, or federal law.
The application is current for only 60 days. At the conclusion of this time, if I have not heard from the Employer and still wish to be considered for employment, it will be necessary to fill out a new application.
I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without cause, and without prior notice. I understand that no representative of the Employer has the authority to make any assurance to the contrary.

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