Application for Employment
(Please Print)
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does not prohibit performance of essential job functions.
Date:
I. Personal Information
Name: Last First Middle
Present Address
Permanent Address (if different than above)
Social Security Number Telephone
Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver’s license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.
Position Applied For:
1. Is there any information we would need about your name or use of another name for us to be able to check your work record? Please specify:
2. Do you have any relatives who are presently (or have formerly been) employed by ?
3. How were you referred to _________________?
4. Have you ever been convicted of a felony? ___ Yes ___ No If yes, please explain:
II. Educational History
School Name/Location Years Completed Degree/Diploma
Elem/Jr. High
High School
College
Tech. Training
Other
III. Employment Record Please include all employment for the last five years.
1.
Company Name (Current or Most Recent Employer) Position Held
Dates Employed:
Address From To
Manager / Supervisor Telephone Wage/Salary
Reason For Leaving
2.
Company Name Position Held
Dates Employed:
Address From To
Manager / Supervisor Telephone Wage/Salary
Reason For Leaving
3.
Company Name Position Held
Dates Employed:
Address From To
Manager / Supervisor Telephone Wage/Salary
Reason For Leaving
NOTE: Use a separate sheet to list additional employers, if necessary . We will contact all of the employers listed on this application unless you specifically exclude them below. Please list any employers you do not want us to contact and your reason for the exclusion:
(Employer’s Name) Reason
(Employer’s Name) Reason
IV. References Please do not include relatives or former employers.
1.
Name Years Known
Address Telephone
Occupation
2.
Name Years Known
Address Telephone
Occupation
3.
Name Years Known
Address Telephone
Occupation
V. Work Availability
1. If your application receives favorable consideration, when will you be available to begin work?
2. Do you have any objection to working overtime? ( ) Yes ( ) No
3. Can you work overtime without prior notice? ( ) Yes ( ) No
4. Can you work on Saturday? ( ) Yes ( ) No
5. Can you work on Sunday? ( ) Yes ( ) No
6. Can you travel if required by this position? ( ) Yes ( ) No
7. Can you work on Holidays? ( ) Yes ( ) No
VI. Salary / Hourly Rate Requirements
If your application receives favorable consideration, what salary/hourly rate would you require?
$ per
