Employment Application
Contact Information
Name
*
First Name
Last Name
Social Security Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Position Applied For:
*
Location:
*
Title:
*
Minimum Accepted Salary:
*
Date Available to Start:
*
-
Month
-
Day
Year
Date
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Education
High School
High School:
*
Received: (check one)
*
Diploma
None
Other
Your Name, if Different While Attending School:
College, University or Professional School:
Transcripts May be Required
Name of School
Location
Date From
-
Month
-
Day
Year
Date
Date To
-
Month
-
Day
Year
Date
Major/Minor Course of Study
Type of Degree
Do you want to add another education entry?
Yes
No
Name of School
Location
Date From
-
Month
-
Day
Year
Date
Date To
-
Month
-
Day
Year
Date
Major/Minor Course of Study
Type of Degree
Do you want to add another education entry?
Yes
No
Name of School
Location
Date From
-
Month
-
Day
Year
Date
Date To
-
Month
-
Day
Year
Date
Major/Minor Course of Study
Type of Degree
Do you want to add another education entry?
Yes
No
Job Related Training or Course Work:
Vocational, Trade, Governmental, Business, Armed Forces, Etc.
Name of School
Location
Date From
-
Month
-
Day
Year
Date
Date To
-
Month
-
Day
Year
Date
Course of Study
Training Complete?
Yes
No
Do you want to add another entry?
Yes
No
Name of School
Location
Date From
-
Month
-
Day
Year
Date
Date To
-
Month
-
Day
Year
Date
Course of Study
Training Complete?
Yes
No
Do you want to add another entry?
Yes
No
Name of School
Location
Date From
-
Month
-
Day
Year
Date
Date To
-
Month
-
Day
Year
Date
Course of Study
Training Complete?
Yes
No
Licensure, Registration, Certification
Examples: A/C Certification, Real Estate License etc.
License, Registration or Certification:
Number
Date Received
-
Month
-
Day
Year
Date
Exp Date
-
Month
-
Day
Year
Date
Licensing Agency
License, Registration or Certification:
Number
Date Received
-
Month
-
Day
Year
Date
Exp Date
-
Month
-
Day
Year
Date
Licensing Agency
License, Registration or Certification:
Number
Date Received
-
Month
-
Day
Year
Date
Exp Date
-
Month
-
Day
Year
Date
Licensing Agency
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Employment History
Employment 1
Name of Present or Last Employer:
*
Address:
*
Job Title:
*
Supervisor's Name:
*
First Name
Last Name
From:
*
-
Month
-
Day
Year
Date
To:
*
-
Month
-
Day
Year
Date
Duties & Responsibilities:
*
Hours per Week
*
Reason for Leaving:
*
Employment 2
Name of Present or Last Employer:
Address:
Job Title:
Supervisor's Name:
First Name
Last Name
From:
-
Month
-
Day
Year
Date
To:
-
Month
-
Day
Year
Date
Duties & Responsibilities:
Hours per Week
Reason for Leaving:
Employment 3
Name of Present or Last Employer:
Address:
Job Title:
Supervisor's Name:
First Name
Last Name
From:
-
Month
-
Day
Year
Date
To:
-
Month
-
Day
Year
Date
Duties & Responsibilities:
Hours per Week
Reason for Leaving:
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Knowledge/Skills/Abilities (KSAs)
List KSAs you possess and believe relevant to the position you seek, for example: computer skills, operating heavy equipment, etc.
*
Citizenship
Are you a US Citizen or are you legally authorized to work in the US?
*
Yes
No
Background Information
Have you ever been convicted of a felony or first degree misdemeanor?
Yes
No
If yes, what charges?
Where convicted?
Date of conviction:
-
Month
-
Day
Year
Date
Have you ever pled no contest or pled guilty to a crime which is a felony or a first degree misdemeanor?
Yes
No
If yes, what charges?
Where?
Date:
-
Month
-
Day
Year
Date
Have you ever had the adjudication of guilt withheld for a crime which is a felony or a first degree misdemeanor?
Yes
No
If yes, what charges?
Where?
Date:
-
Month
-
Day
Year
Date
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References
List three business or work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.
Reference 1
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Years Known
*
Reference 2
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Years Known
*
Reference 3
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Years Known
*
CERTIFICATION
I am aware that any omissions, falsifications, misstatements, or misrepresentations above may disqualify me for employment consideration and, if I am hired, may be grounds for termination at a later date. I understand that any information I give may be investigated as allowed by law. I give the employer the right to investigate all references to secure additional information about me. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations, or organizations for furnishing such information. This employer is an Equal Opportunity Employer. I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of the person's need for accommodation that would be required by the ADA. This application is current for only 60 days. I certify that to the best of my knowledge and belief all the statements in this application and any attachments are true, correct, complete, and made in good faith.
Signature
*
Date
*
-
Month
-
Day
Year
Date
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Affirmative Action Voluntary Information
We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, veteran status or any other legally protected status. Although the following information is not mandatory, it is used to satisfy the Affirmative Action requirements of Section 503 of the Rehabilitation Act or as necessitated by another federal law or regulation.
Position Applied For:
Date
-
Month
-
Day
Year
Date
Sex:
Female
Male
Date of Birth:
-
Month
-
Day
Year
Date
Race:
White (Non-Hispanic)
Black (Non-Hispanic)
Hispanic
Asian or Pacific Islander
Native American
Other
Special Notice
To Vietnam Era Veterans, Disabled Veterans and Individuals with physical or mental disabilities:
Government contractors subject to the Vietnam Veterans Readjustment Act of 1974 and the Rehabilitation Act of 1973 are required to take affirmative action to employ and advance in employment qualified disabled veterans, veterans of the Vietnam era and qualified handicapped individuals.
You are invited to volunteer this information, if you quality, to assist in proper placement and determining reasonable accommodation. This information will be considered confidential. Refusal to provide this information will not adversely affect your consideration for employment.
If you so wish to be identified, please check if any of the following are applicable:
Vietnam era Veteran (served between 1964-1975)
Disabled Veteran
Individual with a disability
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Employee Credit Report Release Form & Employee Criminal Background Release Form
Name
*
First Name
Last Name
Date:
*
-
Month
-
Day
Year
Date
Social Security Number:
*
Date of Birth:
*
-
Month
-
Day
Year
Date
I understand that my Credit Report will be processed upon submission of my employment application to SunStates Management Corporation.
Signature
*
Date
*
-
Month
-
Day
Year
Date
I understand that a Criminal and Sex Offender Background check will be processed upon the submission of my employment application to SunStates Management Corporation.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: