Steinbarger Precision Employment Form

Employment Application Form
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, handicap, or national origin.
PERSONAL INFORMATION
Date

MonthDayYear
Date
Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Email
example@example.com
Referred by
Are you 18 years of age or older?
EMPLOYMENT DESIRED
Position
Date You Can Start

MonthDayYear
Employment Desired
Hourly Desired $
Days/hours available to work
Are you employed now?
Can you work nights?
Where do you work?
How long have you been employed there?
Are you willing to submit to a drug test?
Are you willing to submit to a background check?
Are you eligible to work in the US?
GENERAL
Job Related Skills
EDUCATION
High School/GED
Name of High School Attended
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Years Completed
Did you graduate?
Degrees
College
Name of College/University Attended
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Years Completed
Did you graduate?
Majors/Degrees
Post-Grad
Name of Graduate School Attended
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Years Completed
Did you graduate?
Majors/Degrees
FORMER EMPLOYERS

List below your last 3 employers, starting with the most recent.
Previous Employer 1
Name of Previous Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position
Hourly (Upon Leaving)
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
Previous Employer 2
Name of Previous Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position
Hourly (Upon Leaving)
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
Previous Employer 3
Name of Previous Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position
Hourly (Upon Leaving)
Reason for Leaving?
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
REFERENCES

List below 3 people not related to you, who you have known for at least 1 year.
Reference 1
Name of Reference
Relationship
Years Acquainted
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 2
Name of Reference
Relationship
Years Acquainted
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 3
Name of Reference
Relationship
Years Acquainted
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
AUTHORIZATION
I authorize investigation on all statements contained in this application. I understand that misrepresentation of information requested is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without cause and without any previous notice.
Signature
Date

MonthDayYear
Date
In case of emergency notify:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please verify that you are human
Should be Empty:

Employment Application Form

PERSONAL INFORMATION

EMPLOYMENT DESIRED

GENERAL

EDUCATION

FORMER EMPLOYERS

REFERENCES

AUTHORIZATION