Application For Employment

Personal
Date:
Name:
Street:
City, State, Zip:
Home Telephone:
Business Telephone:
Social Security #:
Pay Expected:
Have you ever applied for employment with us?
If Yes: (Month, Year, and Location)
Position Desired:
Apart from absence for religious observances, are you available for full-time work?
If not, what hours can you work?
Have you been convicted of any crimes in the past ten years, excluding misdemeanors and summary offenses, which have not been annulled, expunged or sealed by a court?
If "yes", describe in full:
Will you work overtime if asked?
When will you be available to begin work?
Have you ever been bonded?
If "yes", with what employers?
Other special training of skills (languages, machine operation, etc)

Education
Name, Location, and Level of School:
Course of Study:
Number of Years Completed:
Did you graduate?
Degree or Diploma:
Name, Location, and Level of School:
Course of Study:
Number of Years Completed:
Did you graduate?
Degree or Diploma:
Name, Location, and Level of School:
Course of Study:
Number of Years Completed:
Did you graduate?
Degree or Diploma:
Name, Location, and Level of School:
Course of Study:
Number of Years Completed:
Did you graduate?
Degree or Diploma:
Name, Location, and Level of School:
Course of Study:
Number of Years Completed:
Did you graduate?
Degree or Diploma:

Employment
Company Name:
Address:
Name Of Supervisor:
State Job Title and Describe Your Work:
Telephone:
Employed (Month and Year - From and To)
Weekly Pay (Start - Last)
Reason For Leaving:
Company Name:
Address:
Name Of Supervisor:
State Job Title and Desribe Your Work:
Telephone:
Employed (Month and Year - From and To)
Weekly Pay (Start - Last)
Reason For Leaving:
Company Name:
Address:
Name Of Supervisor:
State Job Title and Desribe Your Work:
Telephone:
Employed (Month and Year - From and To)
Weekly Pay (Start - Last)
Reason For Leaving:
Company Name:
Address:
Name Of Supervisor:
State Job Title and Desribe Your Work:
Telephone:
Employed (Month and Year - From and To)
Weekly Pay (Start - Last)
Reason For Leaving:
Do Not Contact (Employer Number(s) - Reason or N/A)

Military
Did you serve in the US Armed Forces?
If "yes", in what Branch?
Describe any training relevant to the position for which you are applying.

Additional Information
Membership in professional and civic organization, special accomplishments, awards, etc.
(Exclude those which may disclose your race, color, religion, age or national origin)

Applicant's Signature
I fully understand and accept all terms and conditions in the below statement.
 
   

The information I have provided in this Application for Employment is true, correct and complete. False, incomplete or misrepresented information of any kind, will be sufficient cause for my application to be rejected or, if discovered after I am employed, cause for immediate termination of my employment.

I authorized the employer to contact and obtain information about me from previous employers, educational institutions and “references” I provide, and any other party necessary to verify the accuracy of information I disclosed in this application, a related employment resume or a personal interview. To assist in the processing of my Application, I waive all rights and claims I may otherwise have against the employer or its representatives, for seeking, and using information to evaluate my employment request and all other persons, corporations or organizations who provide information for this purpose.

This application will expire in 30 days. After that date, unless otherwise notified, I understand that my status as an applicant will end. I may re-apply for employment in the future by completing a new application.

This application is not an employment agreement. If I accept an offer of employment I understand that the employer may terminate my employment at any time, with or without cause and without prior notice, unless required by law. I understand that no one, other than an executive officer of the employer, has authority to enter into any employment agreement with terms contrary to the foregoing and then only in writing signed by such officer.