APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT

Ability Focused provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status,genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal,state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion,termination, layoff, recall, transfer, leaves of absence, compensation and training. By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our customers and contributing to the financial success of the organization, its clients, and its employees. Equal access to programs, services, and employment is available to all qualified persons. Those applicants requiring accommodation to complete the application and/or interview process should contact a management representative.
Position(s) Applied for *
Date of Birth*

MonthDayYear
Date
Social Security Number*
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Main Phone Number*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Email*
example@example.com
Please upload your state issued ID. Your application cannot be processed without these documents*

Cancelof
Please upload social security card, or birth certificate. Your application cannot be processed without these documents*

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Please upload your resume here*

Cancelof
Please confirm you uploaded all necessary work required documents. Your application will not be processed until all documents have been submitted.*

YesNo
Have you ever been involuntarily terminated or asked to resign from any job?*

YesNo
Please explain
Please list any other experience, job related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualifications for employment.

EMPLOYMENT EXPERIENCE
EMPLOYMENT EXPERIENCE

Please list the names of your present or previous employers in chronological order with present or most recent employer listed first. Be sure to account for all periods of time. If self-employed, give firm name and supply business references. Add additional page if necessary.
Name of Employer
Supervisor
May we contact?

YesNo
Phone Number
Please enter a valid phone number.
Dates Employed
From mm/dd/yyyy to mm/dd/yyyy
Job Title and Duties
Reason for Leaving
Name of Employer
Supervisor
May we contact?

YesNo
Phone Number
Please enter a valid phone number.
Dates Employed
From mm/dd/yyyy to mm/dd/yyyy
Job Title and Duties
Reason for Leaving
Please explain any gaps in your employment history:

EDUCATION
Please describe your educational background in the table provided below.

Education Info

	School Name	Diploma/Degree	Areas of Study/Major	Specialized Training, Skills, or Extra- Curricular Activities
High School
College/ University
Graduate/ Professional School
Trade School

BUSINESS AND PROFESSIONAL REFERENCES
Please list three professional references of individuals who are not related to you.

References

	Name	Title	Relationship	Phone Number or Email
Reference 1:
Reference 2:
Reference 3:

APPLICANT STATEMENT AND AGREEMENT
Please read and initial each paragraph below. If there is anything that you do not understand, please ask.
I hereby authorize the Company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons,corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.*
Initial Above
In the event of my employment with the Company, I understand that I am required to comply with all rules and regulations of the Company.*
Initial Above
If hired, I understand and agree that my employment with the Company is at-will, and that neither I, nor the Company is required to continue the employment relationship for any specific term. I further understand that the Company or I may terminate the employment relationship at any time, with or without cause, and with or without notice.I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.*
Initial Above
I understand that safety of employees is extremely important to the Company and that the Company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor.I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.*
Initial Above
I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.*
Initial Above
I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard.*
Initial Above
I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable.*
Initial Above

EMPLOYEE EMERGENCY CONTACT FORM

EMERGENCY CONTACT

	Name	Relationship	Address	Phone Number	Email
EMERGENCY CONTACT #1
EMERGENCY CONTACT #2

MY SIGNATURE BELOW ATTESTS TO THE FACT THAT I HAVE READ, UNDERSTAND, AND AGREE TO ALL OF THE ABOVE TERMS.

Clear
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