ACCEL EMPLOYMENT APPLICATION REV4-2024

EMPLOYMENT APPLICATION
Date Completed*

MonthDayYear
Date
This Is A Drug-Free Work Place Offering Equal Employment Opportunities. Applications are received and employees are hired without regard to race, color, sex, religion, age, genetic information, national origin, disability, veteran’s status, military status or service, citizenship status, marital status, AIDS/NIV status, lawful use of a lawful product when not at work, sickle cell or hemoglobin C trait or any other protected classes under state, local, or county regulations.
Applicant Information
Name*
Full Name
Address*

Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Phone*
Preferred Method Of Contact*

Phone CallTextEmail
Tell Us About Yourself
You must answer every question on this application. If a question does not apply, put “N/A.” Please print.
What position are you applying for?*
What are your pay expectations?*
When can you start work? (Date)*

MonthDayYear
Date
How were you referred to us? (If you were referred by a person, please provide the name)*
Have you completed an application here before?*

YesNo
If yes, date/location
Have you been employed here before?*

YesNo
If yes, date/location
Do you have steady transportation to work?*

YesNo
Are you now, or do you expect to be, engaged in any other business or employment while working here?*

YesNo
If yes, please explain
Are you legally eligible to work in the United States?*

YesNo
Please list any vehicles you have driven as part of your work experience, including the type of vehicle, purpose of driving (i.e. deliveries, transportation) and any relevant certifications or licenses held.*
Education

Education*

	Years Completed	Degree Received	Name Of School	Did you Graduate? (Yes/No)
High School or GED
Trade, Business, or Correspondence
College
Graduate School

Licenses / Certificates
Do you hold a Valid Driver's License that is not currently suspended or revoked?*

YesNo
If Yes, in what State?
Have you been convicted of any moving violations in the last 5 years or have any pending moving violations?*

YesNo
Have you ever had any professional license or certificate suspended or revoked?*

YesNo
If Yes, to either of the above 2 questions please list dates and explanation for each.

Employment History / Work Gaps
In the past 7 years have you had any employment gaps over 6 months?*

YesNo
If Yes, Please Explain
Employer*
City*
State*
Phone*
Supervisor’s Name*
Your Position*
Dates Employed (MM/YYYY - MM/YYYY)*
(MM/YYYY - MM/YYYY)
Reason For Separation*
Employer
City
State
Phone
Supervisor’s Name
Your Position
Dates Employed (MM/YYYY - MM/YYYY)
(MM/YYYY - MM/YYYY)
Reason For Separation
Employer
City
State
Phone
Supervisor’s Name
Your Position
Dates Employed (MM/YYYY - MM/YYYY)
(MM/YYYY - MM/YYYY)
Reason For Separation
Employer
City
State
Phone
Supervisor’s Name
Your Position
Dates Employed (MM/YYYY - MM/YYYY)
(MM/YYYY - MM/YYYY)
Reason For Separation
Employer
City
State
Phone
Supervisor’s Name
Your Position
Dates Employed (MM/YYYY - MM/YYYY)
(MM/YYYY - MM/YYYY)
Reason For Separation
Employer
City
State
Phone
Supervisor’s Name
Your Position
Dates Employed (MM/YYYY - MM/YYYY)
(MM/YYYY - MM/YYYY)
Reason For Separation

Agreement and Release
For the purpose of this agreement and release, the organization that has provided you with this application is referred to as “the company,” “this company,” or “you” in the following paragraphs:

The facts set forth above in my application for employment are true and complete. I understand that false statements or omission of information on this application (even if discovered after employment) or any other employment form may lead to dismissal or denial of employment. You are hereby authorized to make any investigationof my personal history, financial, criminal, credit and or motor vehicle records through any investigative or credit agencies or bureaus of your choice. You are also authorized to administer a personality profile or other pre-employment tests and verify my background. A criminal record or sentence is not an automatic disqualification for employment. I agree to submit to any drug or alcohol testing prior to or after employment.

In making this application for employment, I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. I also acknowledge that the company may conduct a search for information about me that is in the public domain, including, but not limited to, information on social networking sites. In exchange for the consideration of my employment application by this company, I hereby release and forever discharge this company (including their directors, officers, employees, and agents) from any liabilities which may result from an investigation of my past and/or present employment or from the disclosure of such information. I authorize the use of any information in this application to verify my statements, and I authorize past employers, doctors, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record.

I understand that if my application is accepted and if I am hired, employment with this company at all times is employment “at will.” It is further understood that this “at will” relationship may not be changed by any written document, verbal statements, or by conduct unless an authorized executive of this company specifically acknowledges such change. I further understand that my “at will” employment may be terminated at any time by this company or myself and includes no guarantee, contract or promise of employment for any specific length of time. I understand that the first 90 days of employment is a new-hire introductory period. Submission of this application does not imply that I will be hired.

I have read, understand, and by my signature consent to these statements:
Signature of Applicant*

Clear
Date*

MonthDayYear
Date
Should be Empty:

EMPLOYMENT APPLICATION

Applicant Information

Tell Us About Yourself

Education

Licenses / Certificates

Employment History / Work Gaps

Agreement and Release