APPLICATION FOR EMPLOYMENT
10998 S. Wilcrest Drive Suite 197 Houston, Texas 77099 | Office (832)770-4626 Fax (888)766-0617
PERSONAL NFORMATION
Name
*
First Name
Last Name
Middle
Address
Address
Street Address Line 2
City
State
Zip
Phone
*
Format: (000) 000-0000.
Social Security Number
D.O.B
*
Website
Email Address
example@example.com
EMPLOYMENT INFORMATION
Position for which you are applying
*
Are you employed at the present time?
Employer's Name
Employer's Address
1. How long have you been with this employer?
Present Salary
2. If offered a position, when can you report for work?
3. If hired can you show proof of your legal right to work in the U.S.?
Yes
No
4. Have you ever been dismissed, or asked to resign from any position?
Yes
No
5. Have you ever been convicted of a felony, or a misdemeanor which resulted in imprisonment? (A yes answer to the question does not necessarily disqualify an applicant from employment.)
Yes
No
If yes to number 4 or 5, please explain
EDUCATION: Please list on the following lines all schools attended and any other pertinent information about your education.
Rows
Name
Subjects Studies (if applicable)
Dates Attended
High School
College
Other
EMPLOYMENT EXPERIENCE: List most recent experience first
Rows
Name & Address
Position(s) Held
Dates (Start-End)
Employer 1
Employer 2
Employer 3
Employer 4
PROFESSIONAL REFERENCE ONLY
Rows
Name & Address (Include City, State, Zip)
Phone
Relationship
Reference 1
Reference 2
Reference 3
Reference 4
"I certify that all the information submitted by me on this application is true and complete, and i understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if i am employed. My employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and i agree that my employment and compensation can be terminated, with or without cause. And with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it's president, and then only when in wrong and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.
*
Print Name
Signature
*
Today's Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please Inform of any events, or responsibilities outside of work. (Please answer referring to a 6 month period)
Do you plan on taking any vacations? Within the next 6 months?
Yes
No
Are you part of any organizations, Groups or committees – that will acquire you any leave of absence? Or days off? If so please explain. (Ex.: School, Church or Charity Work, etc.)
DO NOT WRITE BELOW THIS LINE
INTERVIEWED BY
DATE
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
REMARKS
NEATNESS
ABILITY
HIRED
POSITION
DEPARTEMNT
SALARY
DATE REPORTING TO WORK
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
APPROVED BY
PLEASE INCLUDE RESUME
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COPY OF E&O LICENSE, EVERY STATE LICENSE, VOIDED CHECK AND W-9
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