Application for Employment

Employment Application

DRUG-FREE WORKPLACE
All employees are subject to drug and alcohol testing procedures permitted under federal and state law.

Personal Information

Name (Last, First, Middle):

Contact Phone:

Street Address:

City:

State: Zip:

Email:

Position(s) interested in?

Salary Requirements:
$

Per HourPer Year

Are you over eighteen (18) years of age?

Have you worked for this company before?
YesNo

If yes, when and where:

If hired, can you supply proof that you are legally entitled to work in the United States for any employer?

Type of employment you seek:

Full-timePart-timePer diem (PRN)Temporary

Hours you can work:

AnytimeDaysEveningsWeekends

Education

High School

Name of School

Location of School

Area of Study

Number of years completed

Did you earna degree or diploma?

YesNo

College

Name of School

Location of School

Area of Study

Number of years completed

Did you earna degree or diploma?

YesNo

Graduate School

Name of School

Location of School

Area of Study

Number of years completed

Did you earna degree or diploma?

YesNo

Other School

Name of School

Location of School

Area of Study

Number of years completed

Did you earna degree or diploma?

YesNo

Employment

BEGINNING WITH YOUR MOST RECENT EMPLOYER, LIST ALL EMPLOYMENT INCLUDING MILITARY SERVICE AND SELF- EMPLOYMENT. Please account for all periods of unemployment. All sections of this application must be complete.

If you are presently employed, may we contact your employer for references? YesNo

May we contact you at your place of employment? YesNo

Present or last employer:

Address:

Phone:

Job Title:

Specific duties:

From (Mo/Yr): To:

Supervisor Name:

Supervisor Phone:

Starting Salary:

Ending Salary:

Reason for leaving:

TerminatedVoluntaryInvoluntary

Please explain:

Previous employer #2:

Address:

Phone:

Job Title:

Specific duties:

From (Mo/Yr): To:

Supervisor Name:

Supervisor Phone:

Starting Salary:

Ending Salary:

Reason for leaving:

TerminatedVoluntaryInvoluntary

Please explain:

Previous employer #3:

Address:

Phone:

Job Title:

Specific duties:

From (Mo/Yr): To:

Supervisor Name:

Supervisor Phone:

Starting Salary:

Ending Salary:

Reason for leaving:

TerminatedVoluntaryInvoluntary

Please explain:

Previous employer #4:

Address:

Phone:

Job Title:

Specific duties:

From (Mo/Yr): To:

Supervisor Name:

Supervisor Phone:

Starting Salary:

Ending Salary:

Reason for leaving:

TerminatedVoluntaryInvoluntary

Please explain:


AN EQUAL OPPORTUNITY EMPLOYER

The Company is an Equal Opportunity Employer and does not discriminate in making employment decisions based upon race, color, sex, religion, national origin, age, disability, marital status, sexual orientation, veteran or military status, or any other protected class.

ACKNOWLEDGEMENT AND AUTHORIZATION

I understand that the Company may contact the past employers and/or personal references I have provided to verify my past employment and work record. I authorize all past and current employers, educational institutions, government agencies, and/or personal references to release any and all information concerning my past employment work history, performance, and personal character. I hereby release all such employers, educators, personal references, and the Company from any and all liability resulting from damages I may incur in the reference verification process. I understand that my employment or continued employment is contingent upon my successfully completing reference and background checks.

I also understand that if employed by the Company, my employment is “at-will” and can be terminated at any time for any reason either by myself or the Company. This agreement cannot be modified by any representative of the Company either in writing or verbally.

Finally, I understand it is unlawful for the Company to employ anyone who is neither a citizen of the U.S. nor an alien authorized to work in the U.S. I certify that any U.S. citizenship/work authorization information I provide to the Company is authentic. Further, I certify that all information I have provided on this application is accurate. False information or omission of facts on this application may result in the termination of my employment with the Company.

By checking this box I certify that I have read the above statement and understand its terms.

I Agree

Thank you for your interest and the time you have taken to submit this application