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.
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Full Name __________________ |
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Address |
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Telephone_________________ |
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Date available to start: |
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*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 |
No |
Hours & Days available to work? |
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If under 18, can you provide a work permit? |
Have you ever been convicted of a felony? (This will not necessarily affect your application.)
Yes No If yes, please describe conditions:
*Are you presently employed? Yes No |
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*May we contact your present employer? Yes No |
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Education |
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School Name and Location |
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Year |
Major |
Degree |
High School ________________________________________ |
______ _________ ______ |
College ___________________________________________ |
______ _________ ______ |
Employment History |
(Start with most recent employer) |
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Company Name & Position ________________________________________________________________
Address ________________________________________Telephone ______________________
Name of Supervisor ____________________________________ May we contact? Yes No
Reason for leaving ______________________________________________________________
Company Name & Position________________________________________________________________
Address _______________________________________ Telephone ______________________
Name of Supervisor ____________________________________ May we contact? Yes No
Reason for leaving _____________________________________________________________
References: List three personal references, not related to you, who have known you for more than one year.
Name /Phone ____________________ Name /Phone __________________ Name /Phone____________________
Please list additional references or employment info on back of application
Please Read Before Signing: I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application. I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees. In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. 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 hereby acknowledge that I have read and understand the above statements.
Signature _______________________________________________ Date_________________
