APPLICATIONFOR EMPLOYMENT
We consider applications for all positions without regard to race, color, religion, creed,
gender, national origin, age, disability, sexual orientation, citizenship status, genetic
information or any other legally protected status.
(PLEASE PRINT)
Position(s) Applied For
Date of Application
-
Month
-
Day
Year
Date
How Did You Learn About Us?
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Relative
Inquiry
Employment Agency
Friend
Other
Name
First Name
Middle Initial
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Telephone Number(s)
Format: (000) 000-0000.
Social Security Number (Voluntary)
Rows
:
AM PM
If you are under 18 years of age, can you provide required proof of your eligibility to work?
Have you ever filed an application with us before? If Yes, give date
Have you ever been employed with us before? If Yes, give date
Do any of your friends or relatives, other than spouse, work here?
Are you currently employed?
May we contact your present employer?
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.
Date available for work
-
Month
-
Day
Year
Date
What is your desired salary range?
Are you available to work:
Full-Time
Part-Time
Temporary
(please indicate dates available
Are you currently on "lay-off" status and subject to recall?
Yes
No
Can you travel if a job requires it?
Yes
No
WE ARE AN EQUAL OPPORTUNITY EMPLOYER
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EDUCATION
EDUCATION
Rows
Name and Address of School
Course of Study
Number of Years Completed
Diploma Degree
Elementary School
High School
Undergraduate College
Graduate Professional
Other (Specify)
Describe any specialized training, apprenticeship, skills and extra-curricular activities.
Describe any job-related training received in the United States military.
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EMPLOYMENT EXPERIENCE
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.
1. Employer
Address
Telephone Number(s)
Dates Employed From
To
Work Performed
Job Title
Supervisor
Reason for Leaving
2. Employer
Address
Telephone Number(s)
Dates Employed From
To
Work Performed
Job Title
Supervisor
Reason for Leaving
3. Employer
Address
Telephone Number(s)
Dates Employed From
To
Work Performed
Job Title
Supervisor
Reason for Leaving
4. Employer
Address
Telephone Number(s)
Dates Employed From
To
Work Performed
Job Title
Supervisor
Reason for Leaving
If you need additional space, please continue on a separate sheet of paper.
List professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status:
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ADDITIONAL INFORMATION
Other Qualifications Summarize special job-related skills and qualifications acquired from employment or other experience.
SPECIALIZED SKILLS (CHECK SKILLS/EQUIPMENT OPERATED)
Rows
Spreadsheet
Production/Mobile Machinery (list)
Other (list)
PC/MAC
Typewriter
WPM
Terminal
Spreadsheet
Production/Mobile Machinery (list)
PC/MAC
Word Processing
Other (list)
Typewriter
Shorthand
WPM
WPM
State any additional information you feel may be helpful to us in considering your application.
Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation?
YES
NO
REFERENCES
1.
First Name
Last Name
Phone #
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
2.
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
3.
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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APPLICANT'S STATEMENT
I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Signature of Applicant
Date
-
Month
-
Day
Year
Date
FOR PERSONNEL DEPARTMENT USE ONLY
Arrange Interview
Yes
No
Remarks
INTERVIEWER
DATE
-
Month
-
Day
Year
Date
Employed
Yes
No
Date of Employment
-
Month
-
Day
Year
Date
Job Title
Hourly Rate/ Salary
Should be Empty: