Application for Employment

Application for Employment

80 Lyndon Rd, Fairport, NY 14450 | (585)223-2160
Personal Information
Name*

First NameLast Name
Phone Number*
Email*
example@example.com
Social Security Number*
What is the best time to contact you?*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position Information
What position are you applying for?*
What is your desired employment type?*
What is your desired pay?*
Hourly
What is your available start date?

MonthDayYear
Date
Are you employed?*

YesNo
If so, may we inquire of your present employer?*

YesNo
Are you willing to work overtime? *

YesNo
Ever applied to this company before?*

YesNo
U.S. Military or Naval Services:
Rank:
If driving is a requirement of the job which you are applying, do you have a current, valid driver’s license?*

YesNo
Are you able, at the time of employment, to submit verification of your legal right to work in the U.S.?*

YesNo
Have you ever been convicted of a felony or a crime which is related to the functions or qualifications of the position for which you are applying? (a conviction record will not necessarily be a bar to employment.)*

YesNo
If so, please describe fully the criminal conviction(s) listing the nature of the offense(s) and your rehabilitation since the conviction(s).
Education
Work Experience
List below the last four employers, starting with your present or last place of employment.
Specialized technical skills (i.e. computer programmer/language, equipment operation, special tools or machines used)
Please indicate further information which you feel would be of value in considering application.

Please indicate the days and hours that you prefer to work. Be sure to state AM or PM*

	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
AM
PM

References
Give the names of three persons not related to you, whom you have known at least three years.*
Upon signing this application, I certify that all the foregoing information is a complete and accurate statement of the facts and understand that if any misrepresentation, omission or falsification be discovered, it will constitute grounds for dismissal. I hereby authorize you to conduct any investigation necessary concerning any part of my background related to the position I am seeking. I release all parties from any liability in connection with the provision and use of such information.

I understand and agree that, if employed by this organization, I will abide by its rules and regulations which I understand are subject to change. I further understand that, if hired, my employment is for no definite period of time and may be terminated by either party at any time.
Signature*

Clear
Date*

MonthDayYear
Date
Print Name*
Should be Empty:

Application for Employment

Personal Information

Position Information

Education

Work Experience

References