Tennetek Employment Application

Employment Application
INSTRUCTIONS: We appreciate your interest in our organization. We consider applicants for all positions without regard to race, color, religion, age, sex, disability, national origin, genetic information, U.S. military service or any other state protected group.
Position(s) applied for:
Date of application:

MonthDayYear
How did you learn about us?

AdvertisementEmployment AgencyWalk-inOther
If other:
Full Name:*

First NameLast Name
Current Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:

Area CodePhone Number
Email Address:*
Any other name(s) under which you have been previously employed or under which school records would be located
Names of friends and relatives employed in this organization
If you are under 18 years of age, can you furnish a work permit?

YesNo
Have you ever filed an application with us before?

YesNo
If Yes, give date

MonthDayYear
Date
Have you ever been employed with us before?

YesNo
If Yes, give date

MonthDayYear
Date
Are you a citizen of the U.S. or do you have a valid work permit? (Proof of citizenship or immigration status will be required upon employment)

YesNo
Can you work overtime, if required?

YesNo
Can you work consistently and arrive to work on time?

YesNo
On what date would you be available to work?

MonthDayYear
Date
Are you available to work:

Full TimePart TimeShift WorkTemporary
Can you travel if the job requires it?

YesNo
If yes, are there limitations? Explain.
Have you ever received any training in the United States military related to the jobfor which you are applying?

YesNo
If yes, Please explain.
Have you ever been convicted of a felony?

YesNo
Employment Experience – Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude voluntary work that indicates race, color, religion, gender, national origin, handicap or other protected status. Please account for all time for at least the past five years.
Employer 1
Address
Telephone number(s)
Job Title
Reason for leaving
Employed From:

MonthDayYear
Employed To:

MonthDayYear
Work Performed
May we contact this employer?

YesNo
Employer 2
Address
Telephone number(s)
Job Title
Reason for leaving
Employed From:

MonthDayYear
Employed To:

MonthDayYear
Work Performed
May we contact this employer?

YesNo
Employer 3
Address
Telephone number(s)
Job Title
Reason for leaving
Employed From:

MonthDayYear
Employed To:

MonthDayYear
Work Performed
May we contact this employer?

YesNo
Any additional past employer information:
Education

	High School	Undergraduate/Professional	Graduate/Professional
School Name & Location
Years Completed
Diploma/Degree
Describe Course of Study

Additional Information

Please complete the items below that are relevant to your ability to perform the position for which you are applying.
Describe any specialized training, apprenticeship,skills and extra-curricularactivities:
Describe any honors youhave achieved:
State any additional information you feel may behelpful to us in consideringyour application:
Extracurricular Activities

List professional, trade, business or civic activities and offices or licenses held if relevant to theposition for which you are applying. You may exclude memberships that would reveal sex, race, religion, age, ancestry,handicap or other protected status.
Extracurricular Activities
References

Give name, address and telephone number of three references who are qualified to evaluate your capabilitiesand who are not related to you and are not previous employers.
Reference 1:
Reference 2:
Reference 3:
Special Skills and Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experience. Those applying for clerical positions, please indicate typing speed and familiarity with computer programs,word processing and other office equipment.
Special Skills
Applicant’s Statement
I certify that answers given herein are true and complete to the best of my knowledge. In the event ofemployment, I understand that false or misleading information given in my application or interview(s) may result inwithdrawal of an offer of employment, or if subsequent to employment, may result in dismissal.

I understand this employment application is not to be construed as a guarantee of employment. I furtherunderstand that, should I become employed, my employment with the organization does not constitute any formof contract, implied or expressed, and such employment may be terminated at will either by myself or myemployer upon notice of one party to the other.

I authorize investigation of all statements contained in this application for employment as may be necessary inarriving at an employment decision. You may use this authority to check references with former employers I havelisted, unless otherwise indicated, as well as the personal references listed.
Signature of Applicant*
Enter you fullname to sign
Should be Empty:

Employment Application

Education

Additional Information

Extracurricular Activities

References

Special Skills and Qualifications

Applicant’s Statement