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Employment Application (click here)

Posted on:

Date ______________

Last name ________________________  First name ________________ Middle name________

Street Address _________________________________________________________________

City _____________________  State _______  ZIP _______

Telephone ___________________________ Social Security # ___________________________

 

Position applied for __________________________________________

How did you hear of this opening? __________________________________________

When can you start? _____________________  Desired Wage $______________

Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.) q Yes  q No

Are you looking for full-time employment? q Yes   q No

If no, what hours are you available? ______________

Have you ever been convicted of a felony? (This will not necessarily affect your application.)   q Yes   q No

If yes, please describe conditions. __________________________________________________

______________________________________________________________________________

______________________________________________________________________________

 

Education      

School Name and Location                                        Year      Major   Degree

High School ________________________________________       ______ ______ ______

College ___________________________________________         ______ ______ ______

College ___________________________________________         ______ ______ ______

Post-College _______________________________________         ______ ______ ______

Other Training ______________________________________        ______ ______ ______

In addition to your work history, are there other skills, qualifications, or experience that we should consider? ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

 

Employment History             (Start with most recent employer)

Company Name ________________________________________________________________

Address ____________________________________ Telephone _________________________

Date Started ___________  Starting Wage ____________  Starting Position ________________

Date Ended _____________  Ending Wage ____________  Ending Position ________________

Name of Supervisor ____________________________________

May we contact? q Yes   q No

Responsibilities _______________________________________________________________

_____________________________________________________________________________

Reason for leaving ______________________________________________________________

 

Company Name ________________________________________________________________

Address ________________________________________ Telephone _____________________

Date Started ____________  Starting Wage ____________  Starting Position _______________

Date Ended _____________  Ending Wage ____________  Ending Position ________________

Name of Supervisor ____________________________________

May we contact?   q Yes   q No

Responsibilities ________________________________________________________________

______________________________________________________________________________

Reason for leaving ______________________________________________________________

 

Attach additional information if necessary.

 

I certify 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 hereby 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 statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing.

 

Signature_______________________________________________   Date _________________


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