Online Job Application Form

Name*

First NameLast Name

E-mail*

example@example.com

Phone Number*

Format: (000) 000-0000.

Location Desired

Department:

Position Applying For:

Earliest Possible Start Date

Date

Only U.S. Citizens of clients who have a legal right to work in the U.S. are eligible for employment. Can you, upon employment, submit documentation verifying your legal right to work in the U.S. and your identity?*

YesNo

Have you ever been convicted of a felony?*

YesNo

If yes, please provide explanation below. A conviction will not necessarily disqualify you from employment.

Are you over 18 years of age?*

YesNo

Education

Rows	School Name / City / State	Years Completed	Degree	Major Course of Study
High School
College
Graduate School
Trade / Business School
Other

Other Skills - please list any other job-related skills or qualifications that support your application:

Honors Received

In order to permit a check of your work and educational records, should we be made aware of any change of name or assumed name that you previously used?

YesNo

Identify any relevant names and dates.

Have you had prior educational experience which relates to the job for which you are applying?

YesNo

Please describe your prior educational experience related to this position:

Are you a veteran of the U.S. Military Service?

YesNo

If so, what branch did you serve in?

Please provide military service dates:

Employment Experience*

Employment Experience

Have you ever been dismissed or forced to resign from any employment?

YesNo

Do you have transportation to work?

YesNo

Are you available for overtime if needed?

YesNo

Are there hours, shifts or days you will not work?

YesNo

Do you have any relatives that work here?

YesNo

Relatives that work here:

Spouse

Are you:

currently employeda layoffsubject to recall

May we contact your current employer?

YesNo

May we contact your previous employers?

YesNo

Please identify any exceptions and reasons for not allowing us to contact prior employers:

References

List below any other information or remarks you wish to have considered as part of your application for employment:

Have you filed an application here before?

YesNo

Date of last application:

Date

Have you been employed here before?

YesNo

Dates of employment:

Date

NOTICE TO APPLICANTS: This employer complies with the Americans with Disabilities Act of 1990. During the interview process, you may be asked questions concerning your ability to perform job-related functions. If you are given a conditional offer of employment, you may be required to complete a post-job offer medical history questionnaire and/or undergo a medical examination. If required, all entering employees in the same job category will be subject to the same medical questionnaire and/or examination and all information will be kept confidential and in separate files.

APPLICANT'S STATEMENT
I certify that the answers given herein are true and complete to the best of my knowledge. I authorize the investigation of all matters contained in this application and hereby give the Employer permission to contact schools, previous employers, references, and others, and hereby release the Employer from any liability as a result of such contact. I understand that misrepresentation, omissions of facts or incomplete information requested in this application may remove me from further consideration for employment. In addition, if employed, any misrepresentations or omissions of facts called for in this application will be cause for dismissal at any time without any previous notice.

Applicants accepted for employment should clearly understand that while we make every effort to provide steady, continuous work, we have no employment contracts, and we cannot guarantee the permanence of any position. Job tenure can be affected by many factors including business/economic conditions, changes in laws or employee policies, conformity to our work rules, job performance, etc. And of course, an employee may elect to leave on their own accord to seek other jobs.

I understand that my employment with the Employer is for no specific term and may be terminated by me or the Employer with or without notice or cause at any time. I further understand that no oral promise, employer policy, custom, business practice or other procedure (including the Employer’s Personnel Handbook or any personnel manuals) constitutes an employment contract or modification of the at-will employment relationship between me and the Employer.

The contents of any employee handbook or personnel manuals, as well as other Employer policies and practices, are subject to change or modification by the Employer, solely at its discretion, without notice. I also understand that no supervisor or other official of the Employer (except its Chief Executive Officer, in writing) has the authority to enter into any agreement with me or to make any agreement contrary to the foregoing.

We conduct our business with the highest possible degree of safety and efficiency. Because of this, the Employer may require applicants for employment to undergo blood and/or urinalysis screening for drug or alcohol use as part of our pre-placement physical examination. In addition, all employees of the Employer are subject to blood tests or urinalysis screening for drug or alcohol use.

This application will remain for ninety (90) days. Any applicant wishing to be considered for employment beyond ninety (90) days should reapply.

I agree in advance if there is a workers' compensation or health claim, I the undersigned agree to an illegal substance and alcohol testing and understand that if I test positive my benefits, if any, will be severely cut or none at all.

Signature

Date Signed

Date

This employer is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, religion, national origin, handicap or marital status. We assure you that your opportunity for employment with this Employer depends solely upon your qualifications.

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Application for Employment