Job Application Form

https://form.jotform.com/223343923459157

Position applied for:*

If position not listed, please provide the position you desire:

How did you hear about this position?

If Other, please specify:

Are you able to perform, with or without reasonable accommodations, the essential functions of the position for which you are applying?*

YesNo

Do you have reliable transportation?*

YesNo

Full Name:*

First NameLast Name

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:*

Area CodePhone Number

E-mail:*

Are you 18 years of age or older? (if a Minor, a work permit will be required)*

YesNo

Are you legally authorized to work in the United States by the Social Security Administration?*

YesNo

Have you ever been convicted of a crime?*

YesNo

Are any felony/misdemeanor charges pending against you?*

YesNo

Please give dates, places, charges and disposition of all convictions. Also provide any other information about convictions you would like Greater Midland to consider. Greater Midland will conduct a criminal history background check for all new employees to determine the existence of any arrests resulting in conviction.

Identify all misdemeanor and felony convictions.

What type of employment are you looking for?

When are you available? (ex., Monday through Friday, Noon to 4 pm):

Available start date:

Number of hours per week desired (1-40):

What is your desired rate of pay?

Have you previously been employed by Greater Midland?

YesNo

Do you have relatives working at Greater Midland?

YesNo

If yes, relative's name:

Upload resume and/or cover letter here then skip to Certification and sign. Otherwise continue to complete this form.

Browse Files

Size Limit:5MB Acceptable file types: pdf, docx, xlsx, html, jpg, jpeg, png, gif

Highest level of education completed:

Employer:

End title:

Start Date:

End Date:

Type of employment:

List your responsibilities:

Employer:

End title:

Start Date:

End Date:

Type of employment:

List your responsibilities:

Describe special skills, experiences, training, certifications and acquired licenses that you have not noted in this application, but which would help you in the position(s) you have applied for:

Reference's Name:

First NameLast Name

Occupation or Title:

Relationship to applicant:

Phone Number:

Area CodePhone Number

Reference's Name:

First NameLast Name

Occupation or Title:

Relationship to applicant:

Phone Number:

Area CodePhone Number

Reference's Name:

First NameLast Name

Occupation or Title:

Relationship to applicant:

Phone Number:

Area CodePhone Number

I hereby certify that the facts stated in the application for employment are true and correct. I understand that false statements, misrepresentations or omission of facts requested shall be grounds for denial of employment and, if employed, for immediate dismissal. I authorize Greater Midland to investigate all statements and claims contained within this application and subsequent oral interviews and I acknowledge and agree that Greater Midland may check references from sources other than those personal references listed herein. I hereby release all current and former employers from any charges or damages for releasing any and all employment information, whether subjective or objective, to Greater Midland.

I understand that, if hired, I will be an employee at will and that both I and Greater Midland will have the right to terminate my employment at any time, with or without advance notice and with or without cause. This policy is called "employment at will" and no one other than Greater Midland's Board officers (and only if in writing, signed by an officer and myself) has the authority to alter this agreement, to enter into any written agreement for employment for a specified period of time, or to make any written or oral agreement contrary to this policy.

Signature

Thank you for your submission.

Application for Employment

PERSONAL INFORMATION

AVAILABILITY

EDUCATION

EMPLOYMENT HISTORY

PERSONAL REFERENCES

CERTIFICATION