SM
STRENGTH MANAGEMENT
Application for Employment
An Equal Opportunity Employer
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Equal access to programs, services, and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.
Position(s) applied for:
Date of Application:
-
Month
-
Day
Year
Date
Name:
First Name
Middle Initial
Last Name
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone #:
Mobile/Cell/Other Phone #:
E-mail Address:
example@example.com
Are you legally eligible for employment in this country?
Yes
No
Date available for work:
What is your desired salary range?
Type of employment desired:
Full-Time
Part-Time
Temporary
Are you able to meet the attendance requirements of the position?
Yes
No
Have you ever pled "guilty" or "no contest" to, or been convicted of, a crime?
Yes
No
If Yes, please provide date(s) and details:
Answering "Yes" to these questions 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.
Driver's License # (if driving is an essential job function):
State:
Employment History
Provide the following information for your past four (4) employers, assignments, or volunteer activities, starting with the most recent.
From:
To:
Employer:
Phone #:
Starting Job Title:
Final Job Title:
Address:
Immediate Supervisor and Title:
Summary of Work Performed and Job Responsibilities:
May we contact for reference?
Yes
No
Later
Reason for leaving:
From:
To:
Employer:
Phone#:
Starting Job Title:
Final Job Title:
Address:
Immediate Supervisor and Title:
Summary of Work Performed and Job Responsibilities:
May we contact for reference?
Yes
No
Later
Reason for Leaving:
From:
To:
Employer:
Phone #:
Starting Job Title:
Final Job Title:
Address:
Immediate Supervisor and Title:
Summary of Work Performed and Job Responsibilities:
May we contact for reference?
Yes
No
Later
Reason for Leaving:
From:
To:
Employer:
Phone #:
Starting Job Title:
Final Job Title:
Address:
Immediate Supervisor and Title:
Summary of Work Performed and Job Responsibilities:
May we contact for reference?
Yes
No
Later
Reason for Leaving:
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Page 2
Application for Employment
Skills and Qualifications
Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Educational Background (if job related)
Number of Years Completed
Did You Graduate?
Did You Graduate?
Course of Study
High School
College
Other
References
Name
Telephone
Number of Years Known
1
2
3
Applicant Statement
I certify that all information I have provided to apply for and secure work with the employer is true, complete, and correct.
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) cancel further consideration of this application or (ii) immediately discharge me from the employer's service, whenever it is discovered.
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 secking, gathering, and using such information in the employment process and all other persons, corporations, or organizations for furnishing such information about me.
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