Application for Employment

Educational Background
List last three (3) schools attended, starting with most recent. List number of years completed. Indicate degree or diploma earned, if any. Enter grade point average.
References
List names and telephone numbers of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references that are not related to you.
Additional Information
List professional, trade, business, or civic associations and any offices held.
EXCLUDE MEMBERSHIPS WHICH WOULD REVEAL RACE, RELIGION, NATIONAL ORIGIN, AGE, COLOR, DISABILITY OR ANY OTHER SIMILARLY PROTECTED STATUS.
List special accomplishments, publications, awards, etc. EXCLUDE INFORMATION WHICH WOULD REVEAL RACE, RELIGION, NATIONAL ORIGIN, AGE, COLOR, DISABILITY OR OTHER PROTECTED STATUS.
List any additional information you would like us to consider.

Employment History
Provide the following information from your past and current employers, assignments, or volunteer activities, starting with the most recent.
Employer #1
Employer
Phone #
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title
Dates Employed
From

MonthDayYear
Date
To

MonthDayYear
Date
Immediate Supervisor and Title
Hourly Rate/Salary
Reason for leaving
Summarize the type of work performed and job responsibilities
May we contact for reference?

YesNoLater
Employer #2
Employer
Phone #
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title
Dates Employed
From

MonthDayYear
Date
To

MonthDayYear
Date
Immediate Supervisor and Title
Hourly Rate/Salary
Reason for leaving
Summarize the type of work performed and job responsibilities
May we contact for reference?

YesNoLater
Employer #3
Employer
Phone #
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title
Dates Employed
From

MonthDayYear
Date
To

MonthDayYear
Date
Immediate Supervisor and Title
Hourly Rate/Salary
Reason for leaving
Summarize the type of work performed and job responsibilities
May we contact for reference?

YesNoLater
Comments: You may include explanation of any gaps in employment
Skills and Qualifications: Summarize any special training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Hours
Hours are subject to change.

Please be specific on your availability.

Examples: Noon - Close, Open - Close, 10:00AM - 3:00PM
Salon Hours

Mon-Fri 10:00AM-8:00PM

Sat 10:00AM-6:00PM

Sun CLOSED
Hours you are available to work
I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for my dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history.

I understand that employment at this company is “at will” which means that either this company or I can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor; manager or executive of this company, other than the president has any authority to alter the foregoing.
Initials*
Date*

MonthDayYear
Date
Should be Empty:

Application for Employment

Educational Background

References

Additional Information

Employment History

Employer #1

Employer #2

Employer #3

Hours