Application for Employment

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications. Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application. All questions must be answered...

PERSONAL DATA
Name (last, first, middle)
Street Address and/or Mailing Addres
Home Telephone Number
Work Telephone Number
Date you can start work
Salary Desired
Do you have a High School Diploma or GED? Yes   No
POSITION INFORMATION
Position applying for
Hours Full Time   Part Time
Shifts 1st   2nd   3rd   4th   5th
Status Regular   Temporary
Are you authorized to work in the U.S. on an unrestricted basis? Yes   No
Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.) Yes   No
Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job? Yes   No
Can you perform these essential functions of the job with or without reasonable accommodation? Yes   No
QUALIFICATIONS
School Name Degree Address/City/State
School
Other
SPECIAL SKILLS
REFERENCES
Name Address/City/State Phone Relationship
WORK HISTORY
Job Title #1
Company Name Address/City/State
Start Date End Date
Supervisor's Name Phone Number
Starting Salary Ending Salary
Reason for Leaving May we contact your present employer? Yes   No
Duties:
Job Title #2
Company Name Address/City/State
Start Date End Date
Supervisor's Name Phone Number
Starting Salary Ending Salary
Reason for Leaving May we contact your present employer? Yes   No
Duties:
Applicant Signature
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, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.I acknowledge and understand that the company is an "at will" employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.
Applicant Signature Date


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