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:_______________________