Employment Application Form
Name
First Name
Middle Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Were you referred by someone?
Yes
No
Please give the name of the person who referred you:
First Name
Last Name
Please state when and where
Did you learn about this position through an online posting?
Yes
No
Which One
Are you at least 18 years of age?
Yes
No
Are you at least 16 years of age?
Yes
No
What is your favorite ice cream flavor?
What is your favorite song?
What are your hobbies?
Job Preferences
The position you are applying for
Schedule Preferences
Full Time
Part Time
Seasonal
Other
Number of Hours per Week
Hours
Please indicate the times you are available to work
Rows
Open
Mid
Close
Other
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Work History
Please include your past 5 years of Professional Work Experience
High School/GED Name and Address
Other Training (graduate, technical, vocational):
Please indicate any current professional licenses or certifications that you hold:
Awards, Honors, Special Achievements:
Military Service:
Yes
No
Branch/Specialized training
List any two non-relatives and phone numbers who would be willing to provide a reference for you.
Declaration
I, the applicant undersigned, agree with the following statements:
I declare that all information provided in this form is true and complete.
I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered later.
IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. I UNDERSTAND MY EMPLOYMENT IS TENTATIVE BASED UPON A SUCCESSFUL COMPLETION OF A 10 YEAR CRIMINAL BACKGROUND CHECK.
I acknowledge that I meet all required qualifications for this position and am able to perform the job responsibilities outlined in the job posting.
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Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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