• Application for Employment

  • Date of birth*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Do you speak Spanish?*
  • Date available for work*
     - -
  • Type of employment desired?*
  • Answering "yes" to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account. Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?*
  • Employment History

  • Format: (000) 000-0000.
  • Hourly or salary
  • Hourly or salary
  • May we contact for reference?*
  • Format: (000) 000-0000.
  • Hourly or salary
  • Hourly or salary
  • May we contact for reference?
  • Skills and Qualifications

  • Computer skills
  • Educational Background

    Starting with your most recent school attended, please provide the following information.
  • Completed*
  • Completed
  • 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 schools or personal references who are not related to you.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Applicant Statement

    I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States of America and that federal immigration laws require me to complete an I-9 Form in this regard. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (1) eliminate me from further consideration for employment, or (2) may result in my immediate discharge from the employer’s service, whenever it is discovered. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT. I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement:
  • Date*
     - -
  • List of experience

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