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Application For Employment
(Equal Opportunity Employer)
Name
Address
Area Code & Telephone - Social Security#
Date Available For Employment (mm/dd/year)
If employed and under 18, can you furnish a work permit? Yes No
Have you ever been employed by this company before? Yes No
Are you employed now? Yes No
May we contact your present employer? Yes No
If you checked yes above, Please provide employers name and Telephone.
Are you prevented from lawfully becoming employed in this country because of
visa or immigration status? Yes No
If applying for a position where driving is required, do you have a valid drivers license in this state? Yes No
If Yes, Please enter your drivers license # Please review our Driving Policy before submitting this application.
Can you perform the essential function of the job (s) for which you are applying? Yes No
Are you available for work? Full-Time Part -Time Over-Time
Have you ever been convicted of a felony? Yes No
(Please note that a "Yes" answer will not bar you from consideration for employment.)
If Yes, Please explain:
This Company is a equal opportunity employer. All applicants will be considered without regard to age, race, national origin, religion,
disability, sex, or other protected status in accordance with applicable federal and state equal opportunity laws. This company will
strive to accommodate any physical or mental limitations of employees or applicants in order to accomplish the essential functions of the
job.
Education
Special Skills, Qualifications and Considerations
Summarize special skills and qualifications, volunteer activities, military experience, employment or other activities related to the job you are seeking:
.
References
Please list three references who are not related to you and are not previous employers.
Name Address City Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Phone
Employment Experience
Start with your present or last job.
#1.
1. Employer Address City Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Phone
Position Held Reason for Leaving
Date Employed From (mm/dd/yy) Date Employed to (mm/dd/yy) Rate of pay hourly/Salary
Duties or Work Performed
What did you like most about your job?
Reason for Leaving?
#2.
#3.
#4.
PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SUBMITTING THIS APPLICATION.
By submitting this application I certify that the answers and statements I have made on this application are true and complete without omissions, to the best of my knowledge.
I also authorize THE COMPANY to investigate of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that any false information provided by me will likely result in a refusal to hire or immediate discharge if I am employed. I authorize any of the persons or organizations named in this application to give you complete information and records regarding my employment, education, character and qualifications.
If hired I will be responsible for familiarizing myself with all rules and regulations of THE COMPANY as they presently exist or are modified. If hired, I understand my employment can be terminated, at the discretion of THE COMPANY or at my option, without notice, at any time and for any reason.
I also understand that no representative of THE COMPANY has the authority to enter into any employment agreement for any specified period of time, or terms and conditions of employment, except as specifically stated in a current written agreement signed by the president of THE COMPANY.
I understand this application is not an offer of employment and no promises or representations of employment have been made to me at this time.
By checking this box you accept these terms and conditions Select Accept Decline and you Agree that the information submitted herein is true to the best of your knowledge.
Please provide us with your e-mail address for conformation of receipt of this application. Email
This application for employment shall be considered active for a period of time not to exceed 90 days from today's date . Any applicant wishing to be considered for employment beyond this time period should submit a new application.
(AFTER SUBMITTING THIS APPLICATION YOU WILL HAVE THE OPTION TO PRINT AND SIGN THIS APPLICATION.)