APPLICATION FOR EMPLOYMENT
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, 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?
Advertisement
Friend
Inquiry
Employment Agency
Relative
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
Email Address:
example@example.com
Driver's License Number
Expiration Date
-
Month
-
Day
Year
Date
DMV driving record is required
Applicants will be subject to Drug Testing prior to employment
Best time to contact you at home
Hour Minutes
AM
PM
AM/PM Option
If you are under 18 years of age, can you provide required proof of your eligibility to work?
Yes
No
Have you ever filed an application with us before?
Yes
No
If Yes, give date
Have you ever been employed with us before?
Yes
No
If Yes, give date
Do any of your friends or relatives, other than spouse, work here?
Yes
No
If Yes, state name, and relationship
Are you currently employed?
Yes
No
May we contact your present employer?
Yes
No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration staus will be required upon employment.
Yes
No
Date available for work
-
Month
-
Day
Year
Date
What is your desired salary/hourly rate?
Are you available to work:
Full Time
Part Time
Mornings
Afternoon
Evenings
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
EDUCATION
EDUCATION
Rows
Name & Address of School
Years Completed
Diploma/Degree
High School
Other
Back
Next
WORK 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.
Employer
Address
From
To
Work Performed
Telephone Number(s)
Format: (000) 000-0000.
Starting/Present Job Title
Hourly Rate/Salary Starting
Final
Supervisor
May We Contact?
Yes
No
Reason for leaving
Employer
Address
From
To
Work Performed
Telephone Number(s)
Format: (000) 000-0000.
Starting/Present Job Title
Hourly Rate/Salary Starting
Final
Supervisor
May We Contact?
Yes
No
Reason for leaving
Employer
Address
From
To
Work Performed
Telephone Number(s)
Format: (000) 000-0000.
Starting/Present Job Title
Hourly Rate/Salary Starting
Final
Supervisor
May We Contact?
Yes
No
Reason for leaving
Comments: Include explanation of any gaps in employment.
Describe any specialized training, apprenticeship, skills and extra-curricular activities.
Note to Applicates: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREDMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given.
Yes No
Yes
No
PERSONAL/PROFESSIONAL REFERENCES
PERSONAL/PROFESSIONAL REFERENCES
Rows
Name
Phone Number
Best Time to Call
Occupation
1
2
3
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. 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 employer.
Signature of Applicant
Date
-
Month
-
Day
Year
Date
WE ARE AN EQUAL OPPORTUNITY EMPLOYER
cut here
For Statistical Purpose Only
Race circle one White Native American or Alaskan Native Black Hispanic Asian or Pacific Islander
White
Native American or Alaskan Native
Black
Hispanic
Asian or Pacific Islander
Sex circle one Male Female
Male
Female
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