Clone of Anointed Employment Application

ANOINTED4SERVICES, LLC

P O Box 3163

HUNTSVIILE, AL 35810-0163

www.anointed4services.net

APPLICATION FOR EMPLOYMENT

Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex. age. national origin, ancestry. physical or mental disability. or veteran status.

Application Date

Date

Name*

First nameMiddle nameLast name

Address*

City*

State*

ZIP

Phone Number*

Please enter a valid phone number.

Social Security #

Position applied for*

How did you hear of this opening?

Have you ever been employed by this agency?

YesNo

When?

Are you presently employed?*

YesNo

May we contact your present employer?*

YesNo

Are you willing to travel?*

YesNo

If yes, mile radius?

Do you have reliable transportation?*

State Required Insurance?*

Date you can start*

Desired Starting pay/rate*

pay/rate per*

Please list applicable skills

High School*

Highest Grade Completed Year Major Degree*

College

Year Major Degree

College

Year Major Degree

Other Training

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

Do you or have you ever held a professional license? , If so, list each state(s) and licensure number(s).

Have you ever had a professional license revoked, denied or suspended? If explain.

Will you consent to a mandatory control substance test?

Are you willing to participate in a random drug and alcohol testing program?

Name Emergency Contact #1

Relation

Address

Phone

Name Emergency Contact #2

Relation

Address

Phone

(Start with most recent employer)

Company Name*

Address

Telephone*

Date Started*

Date

Starting Position*

Date Ended

Date

Ending Position

Name of Supervisor*

May we contact?

YesNo

Responsibilities*

Reason for leaving*

Company Name*

Address

Telephone*

Date Started*

Date

Starting Position*

Date Ended*

Date

Ending Position

Name of Supervisor*

May we contact?

YesNo

Responsibilities*

Reason for leaving*

Company Name*

Address

Telephone*

Date Started*

Date

Starting Position*

Date Ended

Date

Ending Position

Name of Supervisor*

May we contact?

YesNo

Responsibilities*

Company Name

Address

Telephone

Date Started

Date

Starting Position

Date Ended

Date

Ending Position

Name of Supervisor

May we contact?Yes No

Name of Supervisor

Responsibilities

Reason for leaving

List four references (personals and professionals) not related to you, who have known you for more than one year. Please identify as personal (per) or professional (pro)

Name*

Phone*

Years Known*

Address

City*

State*

Per/Pro

Name*

Phone*

Years Known*

Address

City*

State*

Per/Pro

Name*

Phone*

Years Known*

Address

City*

State*

Per/Pro

Name*

Phone*

Years Known*

Address

City*

State*

Per/Pro

I, ____________________________________________,certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.

I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended. or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees/contractors. In compliance with the Immigration Reform and Control Act of 1986. I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. I have received from the company a list of the approved documents that are required. 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 hereby acknowledge that I have read and understand the above statements.

Type Your Name Here

Signature*

Date*

Date

Email*

example@example.com