Application for Employment

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

Position(s) Applied For:
Date of Application:
How Did You Learn About Us?
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Friend
Inquiry
Employment Agency
Relative
Other
Last Name:
First Name:
Middle Initial:
Street Address:
City:
State: Zip Code:
Home Phone:
Work Phone:
SSN:
The best time to contact you at home is:
If you are under 18 years of age, can you provide proof of eligibility to work?
Yes No
Have you ever filed an application with us before?
If Yes, please give the date:
Yes No
Do any of your friends or relatives, other than spouse, work here?
Yes No
If Yes, please state:
Name:
Relationship:
Location:
Are you currently employed?
Yes No
May we contact your present employer ?
Yes No
Are you prevented from lawfully being employed in this country because of Visa or Immigration Status?
 Yes No
Date available for work:
What is your desired salary range:
Are you available to work:
Full Time
Shift(s): 1
2
3
Part Time
Mornings
Afternoon
Evenings
Temporary
From:
To:
Are you currently on "lay-off" status and subject to recall?
Yes No
Can you travel if the job requires it?
Yes No
WE ARE AN EQUAL OPPORTUNITY EMPLOYER
Education
School
Name and Address of School
Course of Study
Years Completed
Diploma or Degree
High School
Undergraduate College

Graduate/ Professional
Other (Specify)
Work Experience (Please begin with your present or last job, including any job-related military service and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status)
Employer:
Address:
Telephone #:
Starting Job Title:
Present Job Title:
Supervisor:
Reason for Leaving:
Dates Employed
From:
To:
Hourly Rate/Salary
Starting:
Final:
Work Performed
Employer:
Address:
Telephone #:
Starting Job Title:
Present Job Title:
Supervisor:
Reason for Leaving:
Dates Employed
From:
To:
Hourly Rate/Salary
Starting:
Final:
Work Performed
Employer:
Address:
Telephone #:
Starting Job Title:
Present Job Title:
Supervisor:
Reason for Leaving:
Dates Employed
From:
To:
Hourly Rate/Salary
Starting:
Final:
Work Performed
Employer:
Address:
Telephone #:
Starting Job Title:
Present Job Title:
Supervisor:
Reason for Leaving:
Dates Employed
From:
To:
Hourly Rate/Salary
Starting:
Final:
Work Performed
Comments (Include explanation of any gaps in employment):
Descibe any specialized training, apprenticeship, skills and extra-curricular activities:
Describe any job-related training recieved in the United States military:
List professional, trade, business or civic activities and offices held:
Additional Information (Other Qualifications):
Specialized Skills
Terminal
Spreadsheet
Production/Mobile Machinery (list)
Other (list)
PC/Mac
Word Processing
Typewriter
Shorthand
WPM:
WPM:
Additional information you would like us to consider:

Note to Applicants: DO NOT ANSWER THE FOLLOWING QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accomodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given.

Yes
No
Personal / Professional References (Do not include family members or past supervisors)
Name
Phone Number
Best Time to Call
Occupation
1.
2.
3.

Applicant's Statement:

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment 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 45 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 have read the Applicant's Statement and agree to all of its terms and conditions.