Employment Application

EMPLOYMENT APPLICATION

(Pre-Employment Questionnaire) (An Equal Opportunity Employer)
Personal Information
Your Name*

First NameMiddle NameLast Name
Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the above address your permanent address?

YesNo
Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Are you 18 years or older?*

YesNo
Are you prevented from lawfully becoming employed in this country because of visa or immigration status?*

YesNo
Employment Desired
Position you are interested in?*
Date you are available to begin work*

MonthDayYear
Date
Salary Required
Please indicate hourly/monthly/yearly etc.
Are you currently employed?*

YesNo
Have you ever applied to this company before?*

YesNo
Please indicate where and approximately when you applied with us previously.
If you were referred to us, whom referred you?
Educational Background
Did you attend High School or take GED courses?*

YesNo
Did you graduate from High School or receive your GED?

YesNo
Name of High School attended, or location of GED Program:
Did you attend college or trade school?

YesNo
Please tell us the location/locations of the colleges or trade schools you attended, the amount of years attended, the diploma/degree attained, and the course of study.
General Information
Please name any subjects of special study, special skills you may have that could benefit your working with us?
Have you been or are you currently a member of the US Military (Active/National Guard or Reserves)?*

YesNo
Are you currently a member of the National Guard or Reserves?

YesNo
What was the last rank you attained or are currently?
Former Employers

List below the last three employers, starting with the last/current one first.
Name of most recent or current employer?
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Begin Employment Date

MonthDayYear
Date
End Employment Date

MonthDayYear
Date
What was your position?
Reason for leaving?
Name of employer #2?
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Begin Employment Date

MonthDayYear
Date
End Employment Date

MonthDayYear
Date
What was your position?
Reason for leaving?
Name of employer #3?
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Begin Employment Date

MonthDayYear
Date
End Employment Date

MonthDayYear
Date
What was your position?
Reason for leaving?
REFERENCES

Give the names of three persons not related to you, whom you have known at least one year.
Name of Reference #1
Business Association of Reference #1
Address of Reference #1
Phone number of Reference #1
Please enter a valid phone number.
How many years have you been acquainted with Reference #1?
Name of Reference #2
Business Association of Reference #2
Address of Reference #2
Phone number of Reference #2
Please enter a valid phone number.
How many years have you been acquainted with Reference #2?
Name of Reference #3
Business Association of Reference #3
Address of Reference #3
Phone number of Reference #3
Please enter a valid phone number.
How many years have you been acquainted with Reference #3?
Disclosures & Submission
The following statement applies in: Maryland & Massachusetts.

It is unlawful in the State of either Maryland or Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
I am completing this application in the following State.

State other than Maryland or MassachusettsMarylandMassachusetts
Since I am completing this application in either the State of Maryland or Massachusetts, I am required to sign that I have read and understand the above statement.

Clear
Name of emergency contact
Address of emergency contact
Phone number of emergency contact
Please enter a valid phone number.
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 its 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.
Signature*

Clear
Please verify that you are human*
Should be Empty:

Personal Information

Employment Desired

Educational Background

General Information

Former Employers

REFERENCES

Disclosures & Submission