APPLICATION FOR EMPLOYMENT
Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age marital or veteran status, or the presence of a non-job related medical condition or handicap. (PLEASE PRINT) Date of Application _____________________ Position(s) Applied For ____________________________________________________________ Referral Source: Advertisement Friend Relative Walk-In Employment Agency Other __________________________________
Name ____________________________________________________________________________
Last First Middle
Address __________________________________________________________________________
Number Street City State Zip Code
( ) Telephone ___________________________ Social Security Number ______________________
Area Code
If employed and you are under 18, can you furnish a work permit? Have you filed an application here before? Have you ever been employed here before?
Are you employed now? Yes No
Yes
No
Yes Yes
No No
If yes, give date _____________ If yes, give date _____________
Yes No
May we contact your present employer?
If hired, can you furnish proof you are legally entitled to work in the United States?
Yes
No
On what date would you be available to work? ________________________ Are you available to work Full Time Part-Time Yes No Yes No Shift Work Temporary
Can you travel if a job requires it?
Have you been convicted of a felony within the last 7 years?
(Conviction will not necessarily disqualify applicant from employment.)
If Yes, please explain ______________________________________________________________________
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AN EQUAL OPPORTUNITY EMPLOYER M/F/V/H
EMPLOYMENT EXPERIENCE
Start with your present or last job. Include military service assignments and volunteer activities. All information should be completed and reasons for any time lapse should be noted.
Employer Address Job Title Supervisor Reason for Leaving
Telephone
Dates Employed From To Hourly Rate/Salary Starting Final
WORK PERFORMED
Employer Address Job Title Supervisor Reason for Leaving
Telephone
Dates Employed From To Hourly Rate/Salary Starting Final
WORK PERFORMED
Employer Address Job Title Supervisor Reason for Leaving
Telephone
Dates Employed From To Hourly Rate/Salary Starting Final
WORK PERFORMED
Employer Address Job Title Supervisor Reason for Leaving
Telephone
Dates Employed From To Hourly Rate/Salary Starting Final
WORK PERFORMED
Employer Address Job Title Supervisor Reason for Leaving
Telephone
Dates Employed From To Hourly Rate/Salary Starting Final
WORK PERFORMED
If you need additional space, please continue on a separate sheet of paper.
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Special Skills and Qualifications
Summarize special skills and qualifications acquired from employment or other experience such as specific office skills, machines used, etc.
Veteran of the U.S. Military service?
Yes
No
If Yes, Branch ____________________
List professional, trade, business or civic activities and offices held. (You may exclude those which indicate race, color, religion, sex or national origin): ______________________
Give name, address and telephone number of three references who are not related to you and are not previous employees.
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EDUCATION
Elementary School Name Years Completed (circle) 4 Diploma/Degree Describe Course of Study Describe Specialized Training, Apprenticeship, Skills, and ExtraCurricular Activities 5 6 7 8 9 10 11 12 1 2 3 4 High
College/University Graduate/ Professional
Honors Received: State any additional information you feel may be helpful to us in considering your application.
Applicants Statement
I understand this application is considered current for 90 days. If I want to be considered for employment after that time, I must renew my application in writing. I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not and is not intended to be a contract of employment. I further understand said background check may also involve the Companys obtaining an investigative consumer report on me which may cover such areas as my character, general reputation and mode of living. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
Signature of Applicant
Date
For Personnel Department Use Only Arrange Interview Yes No Remarks ______________________________________________________________________________ _____________________________________________________ _____________________
Interviewer Date
Employed
No Date of Employment ___________________ Hourly Rate/ Job Title _____________________ Salary ___________ Department _____________________ By_____________________________________
Name and Title
Yes
_______________
Date
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