|
|
APPLICATION FOR EMPLOYMENT
It is our policy to provide equal employment opportunity to all qualified persons
without regard to race, creed, color, religious belief, sex, age, national origin,
ancestry, or veteran status.
PERSONAL
NAME: Last First M.I
Street Address
City State Zip
Home Phone #
Cell Phone #
Social Security #
Are you 18 or older [ ]Yes [ ] No If no, date of birth / /
In case of emergency, contact:
Name Phone
Are you:
[ ] A citizen or national of the
[ ] An alien lawfully admitted for permanent residence
(Alien Number A
[ ] An alien authorized by the USCIS to work in the
(# Or Admission Number
Expiration of employment authorization
POSITION
How did you hear of this opening?
Mon
When can you start? Desired wages per hour.
Hours Available
Tue
Wed
Thur
Fri
Sat
Sun
From
To
Have you ever been convicted of a crime other than a minor traffic violation?
(Answering Yes will not automatically disqualify you for employment.)
[ ] Yes [ ] No
If yes, please describe the circumstances:
EDUCATION
Highest Grade completed Current Grade GPA
EMPLOYMENT HISTORY
Company Name
Address
Phone
Date Started Starting Wage
Starting Position
Date Ended Ending Wage
Ending Position
Name of Supervisor
May we contact? [ ] Yes [ ] No
Responsibilities
Reason for leaving
Company Name
Address
Phone
Date Started Starting Wage
Starting Position
Date Ended Ending Wage
Ending Position
Name of Supervisor
May we contact? [ ] Yes [ ] No
Responsibilities
Reason for leaving
Describe any education or training you have which is not covered above,
such as vocational school, correspondence courses, service schools, in-service
training or volunteer work which you feel is relevant to the job for which you
are applying. Also include any relevant licenses
or certificates. Be specific.
PLEASE READ CAREFULLY
I understand that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is herby authorized to make any investigations of my prior educational and employment history. I understand that employment at this company is “at will”, which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statue. All employment will continue on that basis. I understand that no supervisor, manager, or executive of this company, other than the owners, has the authority to alter the foregoing.
Signature Date