Application for Employment

Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran status.

Date*

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Last Name*

First Name*

Middle Name

Street Address*

City*

State*

ZIP*

Email*

Telephone*

Position Applied For*

How Did You Hear of this Opening?*

When Are You Available to Start?*

Desired Wage $*

Are You a U.S. Citizen or Otherwise Authorized to Work in the U.S. on an Unrestricted Basis? (You May be Required to Provide Documentation.)*

Yes

Are You Looking for Full-Time Employment?*

Yes

Are You at Least 18 Years Old?*

Yes

What Hours Are You Available?*

Are You Willing to Work Overtime?*

Yes

Have You Ever Been Convicted of a Felony? (This Will Not Necessarily Affect Your Application.)*

Yes

If Yes, Please Describe Conditions.

Education

High School*

Address*

Dates Attended*

Completed*

Yes

High School Diploma or Equivalent?*

Yes

College

Address

Dates Attended

Completed

Yes

Degree

Other Training

Dates Attended

Completed

Yes

In Addition to Your Work History, Are There Other Skills, Qualifications, or Experience That We Should Consider?

Employment History

Start with most recent employer

Company Name*

Address*

Telephone*

Date Started*

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Date Ended*

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Starting Wage*

Ending Wage*

Starting Position*

Ending Position*

Name of Supervisor*

May We Contact?*

Yes

Responsibilities*

Reason for Leaving*

Company Name

Address

Telephone

Date Started

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Date Ended

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Starting Wage

Ending Wage

Starting Position

Ending Position

Name of Supervisor

May We Contact?

Yes

Responsibilities

Reason for Leaving

Company Name

Address

Telephone

Date Started

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Date Ended

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Starting Wage

Ending Wage

Starting Position

Ending Position

Name of Supervisor

May We Contact?

Yes

Responsibilities

Reason for Leaving

Company Name

Address

Telephone

Date Started

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Date Ended

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Starting Wage

Ending Wage

Starting Position

Ending Position

Name of Supervisor

May We Contact?

Yes

Responsibilities

Reason for Leaving

Attach Additional Information If Necessary.

I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history.

I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing.

Signature (Please Type)*

Date*

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