Employment Application 3333 S. Wadsworth Blvd. C-107 303-986-6240 Programs, services and employment are equally available to everyone. Please inform the Human Resources Department if you require reasonable accommodation for the application or interview. Date of Application: _____________ Applicant Information Full Name: Address: Phone: City: State: Cell: E-mail: Date available to start: Salary Req. Are you over the age of 18? Yes No If no when will you turn 18? Are you a citizen of the United States? Yes Full Time ________________________ No If not, are you legally allowed to work in the United States? Type of employment desired? Zip: Part Time Yes No Seasonal Temporary How Many Hours & Days are you looking for: Hours/Week______Days/Week______ Have you ever pleaded guilty, no contest or been convicted of a crime? please give dates and details: Yes No If yes, Answering yes to these questions doesn’t constitute an automatic rejection for employment. Date of the offenses, seriousness and nature of the violation, rehabilitation and position applied for will be considered. Do you have reliable transportation that you will use to get to and from work? Please list this transportation ________________________ Summarize your Special Skills or Qualifications ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Availability Please list any hobbies, sports, school activities… that you are actively involved with: Please circle any days and nights that you are AVAILABLE to work: Mon Tues am pm am pm Wed am pm Thurs Fri Sat am pm am pm am pm Are you able to work a min of 2 week days as well as Saturday Yes No If the answer is No please explain_________________________________________________________ Education High School:_______________________________ Years Attended:__________ College:___________________________________ Years Attended:__________ Employment History Previous Employment (begin with most recent) Use the back of this page for additional work history Date of Employment: From / / To Company Name: / / Position held: Address: City: State: Phone: Supervisor: Zip: Title: Responsibilities: Starting Pay rate and title: End. Pay rate and title: Reason for leaving: Please be specific. Use the back of this page if you need more space. May we contact this employer? Yes No If no please state the reason. Date of Employment: From / / To Company Name: / / Position held: Address: City: State: Zip: Phone: Supervisor: Title: Responsibilities: Starting Pay rate and title: End. Pay rate and title: Reason for leaving: Please be specific. Use the back of this page if you need more space. May we contact this employer? Date of Employment: From Yes / No If no please state the reason. / To Company Name: / / Position held: Address: City: State: Phone: Supervisor: Zip: Title: Responsibilities: Starting Pay rate and title: End. Pay rate and title: Reason for leaving: Please be specific. Use the back of this page if you need more space. May we contact this employer? Yes No If no please state the reason. I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby released employers, schools or individuals for all liability when responding to inquiries in connection with my application. In the event that I am employed, I understand that false or misleading information given in my application may result in discharge. Signature of Applicant: ________________________________ Date:_______________________
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