Scott's Employment Application

We Drug Test All New Hires

Programs, services, and employment are equally available to everyone. Please inform the Human Resources Department if you require reasonable accommodation for the application or interview.
Date

MonthDayYear
Date
How were you referred to us
Position Applied For:

SandblasterPainterOther
First Name
Middle Name
Last Name
Address

Address

Street Address Line 2

CityState

Zip
Phone
Mobile/Pager/Other
Date Available To Start

MonthDayYear
Date
Salary Requirement
$Dollar amount
If you are under 18 and we require a work permit, can you furnish one?

YesNo
If no, please explain
Have you ever worked for this company?

YesNo
If yes, when?
Are you a citizen of the United States?

YesNo
If not, are you legally allowed to work in the United States?

YesNo
Type of employment desired:

Full-TimePart-TimeTemporarySeasonal
Have you ever pleaded "guilty," "no contest," or been convicted of a crime?

YesNo
If yes, give dates and details.
Answering "yes" to the above question does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation. rehabilitation and position applied for will be considered.
Driver's license number if applicable to position
State
SUMMARIZE YOUR SPECIAL SKILLS OR QUALIFICATIONS
PREVIOUS EMPLOYMENT (begin with most recent position):
Employer 1
Employment From:

MonthDayYear
Date
Employment To:

MonthDayYear
Date
Position(s) Held
Firm Name
Address
Phone Number
Please enter a valid phone number.
Supervisor
Title
Responsibilities
Starting Salary and Title
Ending Salary and Title
Reason for Leaving
May we contact this employer for reference?

YesNo
Employer 2
Employment From:

MonthDayYear
Date
Employment To:

MonthDayYear
Date
Position(s) Held
Firm Name
Address
Phone
Supervisor
Title
Responsibilities
Starting Salary and Title
Ending Salary and Title
Reason for Leaving
May we contact this employer for reference?

YesNo
Employer 3
Employment From:

MonthDayYear
Date
Employment To:

MonthDayYear
Date
Position(s) Held
Firm Name
Address
Phone
Supervisor
Title
Responsibilities
Starting Salary and Title
Ending Salary and Title
Reason for Leaving
May we contact this employer for reference?

YesNo
I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools, or individuals from all liability when responding to inquiries in connection with my application. In the event am employed. - understand that false or misleading information given in my application or interview(s) may result in discharge.
Signature of Applicant

Clear
Date

MonthDayYear
Date
Should be Empty: