APPLICATION FOR EMPLOYMENT
Answer all questions completely. Incomplete applications cannot be considered.
Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, handicap or veteran status.
P
Last Name
E
Street Address
Home Telephone
City, State, Zip
Business Telephone
R
S
First
How long have you lived at this address?
Middle
Date
How long at previous address?
When will you be able
to begin work?
O
N
Have you ever applied for employment with us?
Yes
No If yes: Month / Year
Have you ever been employed by us?
Yes
No
If yes: Month / Year
Are you at least 18 years old?
Yes
Position Desired:
A
Full-Time
Part-Time
Temporary
Seasonal
Are you legally eligible for employment in the United States?
L
School
Advertisement
Name and Location of School
No
Employee
Course of Study
Relative
No. of Years
Completed
I
High School
Yes
No
Yes
No
Yes
No
O
Yes
Elementary
No
N
REFERENCES:
Degree or Diploma
No
College
T
Did you Graduate?
Yes
U
Business /
Trade
Technical
to employment
Other _______________________
Graduate
A
No
A drug test will be done prior
D
C
Yes
a work permit?
Yes
(Proof of U.S. citizenship, immigration status, or of your eligibility to work will be required upon employment.)
REFERRAL SOURCE:
E
No
If you are under 18, can you furnish
Give name, address, and telephone number of three references not related to you.
Please send a resume if one is available.
F:\SHARED FILES\Application for Employment
EMPLOYMENT
Please give accurate, complete full-time and
part-time employment record. Start with your
present or most recent employer.
Company Name
Telephone
Address
Employed - (State month and year)
From
1
Name of Supervisor
Start
Reason for Leaving
Company Name
Telephone
Address
Employed - (State month and year)
Name of Supervisor
Start
Last
State Job Title and Describe Your Work
Reason for Leaving
Company Name
Telephone
Address
Employed - (State month and year)
Name of Supervisor
To
Weekly Pay
Start
Last
State Job Title and Describe Your Work
Reason for Leaving
Company Name
Telephone
Address
Employed - (State month and year)
From
4
To
Weekly Pay
From
3
Last
State Job Title and Describe Your Work
From
2
To
Weekly Pay
Name of Supervisor
To
Weekly Pay
Start
State Job Title and Describe Your Work
Last
Reason for Leaving
DO NOT CONTACT
Employer Name(s) and Number(s)
Reason
F:\SHARED FILES\Application for Employment
We may contact the employers listed above
unless you indicate those you do not want
us to contact.
MILITARY
Did you serve in the U.S. Armed Forces?
Yes
No
If "Yes", in which Branch?
Describe any training received relevant to the position for which you are applying.
SPECIAL SKILLS AND QUALIFICATIONS
Summarize special job-related skills and qualifications you have acquired (languages, machine operation, etc.)
MEMBERSHIP IN PROFESSIONAL OR CIVIC ORGANIZATIONS
List memberships of civic, trade, professional, or fraternal organizations
(if you believe your involvement is relevant to your ability to perform the job for which you are applying.
MISCELLANEOUS
Do you have any physical condition which might limit your ability to perform the job for which you are applying?
If "Yes", describe this condition and how you can perform the job in spite of it.
Yes
No
STATE NAMES OF RELATIVES AND FRIENDS WORKING FOR US, OTHER THAN YOUR SPOUSE
F:\SHARED FILES\Application for Employment
APPLICANT'S STATEMENT
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.
This application for employment shall be considered active for a period of time not to exceed 90
days. Any applicant wishing to be considered for employment beyond this time period should inquire
as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any
employment relationship with this organization is of an "at will" nature, which means that the Employee
may resign at any time and the Employer may discharge Employee at any time with or without cause.
It is further understood that this "at will" employment relationship may not be changed by any written
document or by conduct unless such change is specifically acknowledged in writing by an authorized
executive of this organization.
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 employer.
I also understand that if I am hired, I will be required to provide proof of identity and legal authorization
to work in the United States and that federal immigration laws require me to complete an I-9 Form.
Signature of Applicant
Date
FOR PERSONNEL DEPARTMENT USE ONLY
Arrange Interview:
Yes
No
Remarks:
Interviewer:
Employed:
Job Title:
Date:
Yes
No
Salary:
By (Name & Title):
Employer
Date of Employment:
Department:
Date:
Person Contacted
1
2
3
F:\SHARED FILES\Application for Employment
Results