BeeHive of Cypress Employment Application Form

Employee Application
Name*

First NameMiddle InitialLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position Desired
Home Telephone
Work Telephone
E-mail
Please read carefully & complete by typing.

An Equal Opportunity Employer: We are an equal opportunity employer, and we will not discriminate on the basis of race, religion, national origin, sex, age, handicap, marital status, or status as a disabled veteran. Information provided on this application will not be used for any discriminatory purpose.

Provide all information requested: Your complete application form will be maintained in our active files for six (6) months from the date of application. You may submit a new application at any time.

Employment Record: Starting with your present or most recent employer, list all previous employers. If more space is required, please continue on a separate sheet. You may attach a resume, but please complete the application as well.
Employment History:
Last or current employer
Type of Business
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor's Name
Supervisor's Telephone

Area CodePhone Number
Base salary
Dates Worked From: Date To: Date
Brief Description of Job Duties
Reason for leaving
Previous Employer:
Last employer
Type of Business
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor's Name
Supervisor's Telephone

Area CodePhone Number
Base salary
Dates Worked From: Date To: Date
Brief Description of Job Duties
Reason for leaving
Education History
High School (Name and Address)
Attended from Date to Date
Graduated?

YesNo
Technical or Professional School Attended (Name and Address)
Attended from Date to Date
Graduated?

YesNo
Major Course
Degree Received
College or University Attended (Name and Address)
Attended from Date to Date
Graduated?

YesNo
Major Course
Degree Received
Outside Activities

(Exclude those indicating race, color, religion, sex, national origin, age, or handicap)
Professional Memberships, certificates, or licenses held
Past and present civic cultural activities - include office held
Principal hobbies
Special Skills
Please list other skills and/or equipment/language experience you have acquired
Have you ever worked with the elderly?

YesNo
Work References

List four references, two of which must be past supervisors. All references must not be related to you and must have knowledge of your qualifications for the position for which you are applying.
Reference 1
Name
Title/Relationship
Address (Street, City, State, ZIP)
Phone # (Include area code)
Occupation
Reference 2
Name
Title/Relationship
Address (Street, City, State, ZIP)
Phone # (Include area code)
Occupation
Reference 3
Name
Title/Relationship
Address (Street, City, State, ZIP)
Phone # (Include area code)
Occupation
Reference 4
Name
Title/Relationship
Address (Street, City, State, ZIP)
Phone # (Include area code)
Occupation
May we contact your present employer?

YesNo
Check shifts that you are willing to work:

NightsPart timeSaturdaySunday
Wage or salary required:
Date available:

MonthDayYear
Date
Resume (Optional):
Resume

Upload a File

Cancelof
I hereby certify that the answers and other information on this application are true and correct and that I understand any mis-representation or omission of facts on my part will be justification for separation from the company’s service, if employed. I understand that my employment may be contingent upon receipt of an alien registration number, verification of birth, and any other pertinent information bearing upon my employment, and that my continued employment depends upon the will of the company or myself. I understand that smoking, using or being under the influence of alcohol or drugs while on the job is prohibited.
Signature

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Employee Application

Employment History:

Previous Employer:

Education History

Outside Activities

Work References

Reference 1

Reference 2

Reference 3

Reference 4

Resume (Optional):

Send Application: