Employment Application
Position(s) applied for Date of Application / /
Name Email Address
Address Home Phone
City, State Zip Cell Phone
Are you legally eligible for employment in the U.S.: Yes: ___ No: ___ (Proof of identity and U.S. citizenship or immigration status and
right to work in the U.S. is required.)
Have you ever been employed by the CP-CARRILLO?: Yes ___ No ___ If yes, please provide dates, position held, and reason
for leaving:
If offered a job and are under 18 years of age, can you furnish a work permit: Yes ______ No ______
Driver’s license number, if position applied for requires driving: _________________________ State: ________ Class: ________
Date available to start work: ____/____/____ I am available to work: Full-time:________ Part-time:_______ Temp: ________
EDUCATIONAL BACKGROUND:
High School name and location: ___________________________________________ Did you graduate? ____________
College/ Trade School name(s) and location:
___________________________________________________________________________
Major / Degree Achieved: ____________________________________________________________________________________
Other Educational Institution(s): _______________________________________________________________________________
Other Degree / Certification Achieved: ___________________________________________________________________________
SKILLS AND QUALIFICATIONS: Summarize special skills and qualifications acquired from employment, membership in professional
organizations or other experiences that may qualify you for work with CP-CARRILLO. Exclude any that indicate race, color, national
origin, ancestry, religion, sex, gender, gender identity, gender expression, sexual orientation, political affiliations or activities, military
service/veteran status, marital status, pregnancy, age, physical or mental disability (including HIV and AIDS), medical condition, or any
other legally protected basis.
REFERENCES:
Name, relation, phone number:
Name, relation, phone number:
Name, relation, phone number:
FRM 62-61 Rev E
EMPLOYMENT HISTORY:
Starting with the most recent, list your prior employers or work experience for the past 10 years. You may include military service and
volunteer activities that are related to job experience.
From ___________ To _____________
Employer / Address / Phone:
Job title and duties:
Last immediate supervisor and title:
Reason for leaving:
From ___________ To _____________
Employer / Address / Phone:
Job title and duties:
Last immediate supervisor and title:
Reason for leaving:
From ___________ To _____________
Employer / Address / Phone:
Job title and duties:
Last immediate supervisor and title:
Reason for leaving:
_________________________________________________________________________________________________
I hereby certify that all of the foregoing information I have supplied in this application is correct and complete. I understand and agree
to allow CP-CARRILLO (“the Company”) to verify the information provided. I further understand that any falsification of information will
constitute grounds for immediate dismissal upon discovery thereof. I give the Company permission to contact any or all of my previous
employers and references for full information and hereby release the Company from any and all liability for doing so. I also understand
that all offers of employment are conditioned upon the satisfactory completion of reference and/or background checks, and the
submission of valid documentation that confirms my identity and authorization to work in the United States.
If employed and in consideration of my employment, I agree to conform to the rules, policies and procedures of the Company. I
understand that, if hired, I will be an at-will employee, which means that I may terminate my employment at any time, that the
Company may transfer, reassign, suspend or demote me at any time, and that my employment may be terminated at any time,
with or without notice and with or without cause. I further understand that no one has any authority to enter into any agreement of
employment for any specified period of time, or to make any agreement contrary to the foregoing other than in a writing signed by the
CFO.
Print Name: Date ______/______/______
Signature of Applicant:
FRM 62-61 Rev E
