Employment Application
General Information
Last Name First Name Middle Name
Have you ever used another name? [ ] Yes [ ] No Date
If yes, please specify for background investigation purpose only:
Current Street Address Apartment/Unit #
City State Zip Code
Home Telephone Number ( ) Mobile Phone Number ( )
Position Applied For Full Time [ ] or Part Time [ ]
How did you hear of this job opening?
[ ] Advertisement [ ] Friend [ ] Walk-In [ ] Relative [ ] Other _____________________________
Education
Number of
Major/Type of Diploma/
Name and Address of School Years
Coursework Degree
Completed
High School [ ] Yes [ ] No
College/University [ ] Yes [ ] No
Trade, Professional
[ ] Yes [ ] No
School or Other
If hired, can you submit evidence of legal authorization to work in the United States? [ ] Yes [ ] No
If under 18 years of age, can you after employment, submit a work permit? [ ] N/A [ ] Yes [ ] No
In what computer software programs are you proficient?
What other experiences or skills do you feel may qualify you for a position with Mockett?
Professional References
Persons familiar with your work or academic background. Please exclude former supervisors.
Name Position and Company Email Address Telephone Number
May we contact them? [ ] Yes [ ] No
Work Experience
Last/Present Employer Telephone Number ( )
Address Your Job Title
Supervisor’s Name and Position
Duties Performed
From: To: Reason for Leaving
May we contact your previous supervisor for a reference? [ ] Yes [ ] No
Company Telephone Number ( )
Address Your Job Title
Supervisor’s Name and Position
Duties Performed
From: To: Reason for Leaving
May we contact your previous supervisor for a reference? [ ] Yes [ ] No
Company Telephone Number ( )
Address Your Job Title
Supervisor’s Name and Position
Duties Performed
From: To: Reason for Leaving
May we contact your previous supervisor for a reference? [ ] Yes [ ] No
Company Telephone Number ( )
Address Your Job Title
Supervisor’s Name and Position
Duties Performed
From: To: Reason for Leaving
May we contact your previous supervisor for a reference? [ ] Yes [ ] No
I hereby certify that the information on this application is correct and complete to the best of my knowledge.
I agree to have any of the statements checked by Mockett, unless I have indicated to the contrary. Further, I understand that
falsification or omission of any material information on this application, if I receive a job offer may be considered sufficient cause
for immediate termination. I agree that if employed, I will abide by all policies and procedures established by Mockett.
I understand that I may be required to undergo drug testing and/or a background check and that my employment is contingent
upon these results. I will be advised if this is required and complete the necessary authorizations. I understand that I am not
obligated to disclose sealed or expunged records of conviction or arrest, nor may Mockett ask me if I have had records sealed or
expunged.
I hereby acknowledge that my employment will be at “at-will”, that I may resign at any time and Mockett may terminate my
employment at any time, with or without cause, and with or without notice, that any assurances of continued employment,
whether written, oral or by conduct, shall not be interpreted as changing the nature of the employment relationship unless
specifically acknowledged in writing by the President of the Company.
Signature of Applicant: _____________________________________________ Date: _______________________________
WE ARE AN EQUAL OPPORTUNITY EMPLOYER
