APPLICATION FOR EMPLOYMENT
Blue Owl Marketing
(BOM) is an equal opportunity employer and does not discriminate against
otherwise qualified applicants on the basis of race, color, creed, religion,
ancestry, age, sex, marital status, national origin, disability or handicap, or
veteran status.
PERSONAL:
Name ________________________________________ Date __________
Last First Middle
Address _______________________________________________________
Number & Street City State Zip Code
Position Sought ____________________ ___ Full Time ___ Part Time
Date Available ________ Salary Desired ________ Phone # _________
Email Address ________
Social Security Number ___________
Are you over 18 years old? __ Yes __ No
Are you legally eligible for employment in the United States? __ Yes __ No
(If offered employment, you will be required to provide documentation to verify
eligibility.)
EDUCATION: Please indicate education or training which you believe
qualifies you for the position you are seeking.
High School: No. of Yrs Completed (circle one) 1 2 3 4
Diploma: __ Yes __ No G.E.D.: __ Yes __ No
School(s) ____________________ City/State ____________________
College and/or Vocational School:
Number of Years Completed (circle one) 1 2 3 4
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SKILLS :
Office: Typing _____ wpm.
__ Microsoft Word __ Excel __ Powerpoint
School(s) ____________________ City/State ____________________
Other Software Skills ___________________________________
Major ____________________ Degrees Earned ____________________
Have you ever been employed in any facility of [Company]? __ Yes __ No
Other Training or Degrees:
If so, please state facility name and location and dates of employment
______________________________
School(s) ____________________ City/State ____________________
Course _______________ Degree or Certificate Earned ______________
RECORD OF CONVICTION :
During the last ten years,
PROFESSIONAL have you
LICENSE OR ever been convicted of a crime other than
MEMBERSHIP:
minor traffic offense?
__License(s)
Type of Yes __ NoHeld__________________________________________
If yes,ofexplain:
State _________________________________________________
[State Name] License Number
___________________________________
(A conviction will not necessarily automatically disqualify you for
employment. Rather,
License Expiration such___________________________________________
Date factors as age and date of conviction, seriousness
and nature of the crime, and rehabilitation will be considered).
Other Professional Memberships ____________________________________
(You need not disclose
EMPLOYMENT: Listmembership
last employerin first,
professional organizations
including U.S. Militarythat may
Service.
reveal information regarding race, color, creed, sex, religion, national origin,
ancestry, age, disability,
May we contact marital
your present status, veteran
employer? ____status
Yes or____
any No
other protected
status.)
If any employment was under a different name, indicate name
_____________
This
Employer application for employment
____________________ Addressis_________________________
good for 30 days only.
Consideration for employment after 30 days requires a new application.
Telephone _______________ Position _______________
Dates of Employment: From _____ To _____
Mo/Yr Mo/Yr
Salary __________ Supervisor ________________ Department __________
Duties _________________________________ FT __ PT __ No. of Hrs.___
Reason for Leaving ______________________________________________
Employer ____________________ Address _________________________
Telephone _______________ Position _______________
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Dates of Employment: From _____ To _____
Mo/Yr Mo/Yr
APPLICANT'S CERTIFICATION AND AGREEMENT
I hereby certify that the facts set forth in the above employment application are
true and complete to the best of my knowledge and authorize BOM) to verify their
accuracy and to obtain reference information on my work performance. I hereby
release (BOM) from any/all liability of whatever kind and nature which, at any
time, could result from obtaining and having an employment decision based on
such information.
I understand that, if employed, falsified statements of any kind or omissions of
facts called for on this application shall be considered sufficient basis for
dismissal.
I understand that should an employment offer be extended to me and accepted
that I will fully adhere to the policies, rules and regulations of employment of the
Employer. However, I further understand that neither the policies, rules,
regulations of employment or anything said during the interview process shall be
deemed to constitute the terms of an implied employment contract. I understand
that any employment offered is for an indefinite duration and at will and that
either I or the Employer may terminate my employment at any time with or
without notice or cause.
Signature of Applicant ________________________ Date: __________
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