Name:
Email Address:
Street Address, City, State & Zip
Telephone:
Position Applied For
Attached an electronic resume.
Referral Source (Please check the appropriate category:
Name of the Referral
If necessary, best time to call you at home is?
May we contact you at work?
If yes, work phone number
If you are under 18, and it is required, can you furnish a work permit?
If no, please explain
Have you submitted an application here before?
If yes, please explain
Have you ever been employed here before? If yes, provide dates & position.
Date available for work.
Type of employment desired?
Will you relocate if job requires it?
Will you travel if job requires it?
If they have been explained to you, are you able to meet the attendance requirements of the position?
If you are unable to work overtime, please explain why.
Driver's license number required if driving may be required in the job for which you are applying.
Have you ever been bonded?
Have you ever pled 'guilty' or 'no contest' to, or have been convicted of a crime? If yes, please provide dates and details.
(Answering YES does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account).
EMPLOYMENT DETAILS
Starting with your most recent employer, provide the following information
Employer Name
Employer's Phone
Employers full address
Starting Job Title / Ending Job Title
Starting Date
Ending Date
Starting Compensation
Ending Compensation:
Commission, Bonus or other compensation
Immediate supervisor and title
Why did you leave?
Summarize the type of work performed and job responsibilities
What did you like most about your position?
What were the things you liked least about the position?
EMPLOYER #2
Employer Name
Employers Phone
Employers full address
Starting Job Title / Ending Job Title
Starting Date
Ending Date
Starting Compensation
Ending Compensation
Commission, bonus or other compensation
Immediate supervisor and title
Why did you leave?
Summarize the type of work performed and job responsibilities
What did you like most about your position?
What were the things you liked least about the position?
EMPLOYER #3
Employers Name
Employers Phone
Employers full address
Starting Job Title / Ending Job Title
Starting Date
Ending Date
Starting Compensation
Ending Compensation
Commission, bonus or other compensation
Why did you leave?
Immediate Supervision and title
Summarize the type of work performed and job responsibilities
What did you like most about your position?
What were the things you liked lest about the position?
RELATED INFORMATION:
To what job-related organizations (professional, trade, etc) do you belong?
Exclude membership that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disability, veterans/reserve national guard or any other similarly protected status.
List organization and offices held
List special accomplishments, publications, awards etc.
In your current or prior job, have you ever written instructions or directions to be followed by employees or customers?
If yes, please explain.
Is there any other job-related information you want us to know about you?
EMPLOYMENT HISTORY
Explain any gaps in your employment, other than those due to personal illness, injury or disability.
If not address on previous pages, have you ever been fired or asked to resign from a job? If yes, please explain
SKILLS AND QUALIFICATIONS
Summarize any special training, skills, licenses and/or certifications that may assist you in performing the position for which you are applying:
Computer Skills.
List other software /computer experience.
EDUCATION BACKGROUND
School, include city & state
Completed
GPA, Major/Minor
School, including city & State
Completed
GPA, Major / Minor
REFERENCES
List names and phone numbers of three business / work references who are NOT related to you and are not previous supervisors. If not applicable, list three school or personal references who are NOT related to you .
Reference name, Title, phone number, include relationship to you and number of years known
Reference name #2,
Title, phone number, include relationship to you and number of years known
APPLICANTS STATEMENT
I certify that all information I have provided in order to apply for and secure work from this employer is true, complete and correct.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview.
I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives, for seeking gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other personas, corporations or organizations for furnishing such information about me.
I understand that this employer does not unlawfully discriminate in employment and no questions on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.
I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without case and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with our without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration.
I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing language are valid unless they are in writing and signed by the employer’s president.
I also understand if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws required me to complete an I-9 in this regard.
I understand that any information provided to me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate any further consideration for employment, or (ii) may result in my immediate discharge from employer’s service, whenever it is discovered.
