Employment Application Form

Employment Application

All applicants are considered for all positions without regard to race, religion, color, sex,gender, sexual orientation, pregnancy, age, national origin, ancestry, physical/mental disability, medical condition, military/veteran status, genetic information, marital status, ethnicity, citizenship or immigration status or any other protected classification, in accordance with applicable federal,state, and local laws. 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 an accommodation to complete the application and/or interview process should contact a management representative.
Position applied for*
Today's date*

MonthDayYear
Date
Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employment Experience

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 company name and supply business references.
Job title and duties*
Dates employed*
From month/year to month/year
Reason for leaving*
Job title and duties*
Dates employed*
From month/year to month/year
Reason for leaving*
YesNo
If yes, explain below.
Explain any gaps in your employment history.
List any other experience, job-related skills, additional languages or other qualifications that you believe should be considered.
Education

Describe your educational background in the table provided below.
References

List three professional references of individuals who are not related to you.
Reference*
Reference*
Reference*
General Information
YesNo
YesNo
If yes to either of the above, explain:
YesNo
YesNo
If yes, list name(s) and relationship(s):
On what date are you able to begin work?*

Rows	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Days/hours available

Full timePart time
YesNo
YesNo
YesNo
YesNo
YesNo
Note: We comply with the Americans with Disabilities Act and consider reasonable accommodation measures that may be necessary for qualified applicants/ employees to perform essential job functions.
Applicant Statement and Agreement

Read each paragraph and check the box below to signify completion. Ask if there is anything that you do not understand.
Statement 1: 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.
Yes
Statement 2: 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.
Yes
Statement 3: I understand that the 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.
Yes
Statement 4: 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.
Yes
Statement 5: 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 law requires me to complete an I-9 Form in this regard.
Yes
Statement 6: 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.
Yes
My signature attests to the fact that I have read, understand and agree to all of the above terms.
Signature*

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Printed name*
Today's date*

MonthDayYear
Date
Resume and Files*

Cancelof
Cover letter*
Should be Empty:

Employment Application

Employment Experience

Education

References

General Information

Applicant Statement and Agreement