Endless Horizons Employment Application Form

Application for Employment

All statements made by applicants for employment on this application form will be checked for accuracy. We offer equal employment opportunities to all persons without discrimination on the basis of race, color, religion, age, sex, national origin, citizenship status, physical or mental disability, or past, present, or future service in the Uniformed Services of the U.S., or any other legally protected status. The use of this form does not mean there are positions open and does not obligate us in any way.
Name:*

First NameMiddle NameLast Name
E-mail Address:*
Phone Number:*

Area CodePhone Number
Date of Birth*

MonthDayYear
Date
Driver's License #*
State of License*
Name on License*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Can you produce documented proof of your eligibility for employment in the U.S.? (Driver's License, Social Security Card, INS Documents, etc.) *

YesNo
Please provide the position(s) you are applying to*
How soon can you report to work?*
Rate of pay expected
Type of employment desired*

Full-timePart-TimeTemporary
What days and hours, if part-time?

Education

	Name	Major	Year Completed	Degree Earned
High School
College
Post Graduate

How were you referred to us?

Walk-InEmployee ReferralNewspaper AdCollege RecruitmentOnline SearchOther (please specify)
Other:
Have you ever been refused a bond?*

NOOther
Have you ever been convicted of a violation of the law except a minor traffic violation? (A conviction will not necessarily disqualify you from employment)*

NOOther
Have you held a position of trust (handling money or confidential material)?*

NOOther

References

Please list three (3) references that are familiar with your work life.
Reference 1
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Years Known:*
Reference 2
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Years Known:*
Reference 3
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Years Known:*
Prior Work Record (Start with most recent/present employer and complete in full)
1. Name of Most Recent Employer*
Job Title/Duties*
Supervisor's Name and Phone Number*
May we contact?*

YesNo
Date HiredDate Left
Starting RateLast Rate
2. Name of Other Recent Employer
Job Title/Duties
Supervisor's Name and Phone Number
May we contact?

YesNo
Date HiredDate Left
Starting RateLast Rate
3. Name of Other Recent Employer
Job Title/Duties
Supervisor's Name and Phone Number
May we contact?

YesNo
Date HiredDate Left
Starting RateLast Rate
Please provide any additional information such as special skills, training, experience, equipment operation, or other qualifications you feel will be helpful to us in considering your application
Upload Resume:

Upload a File

Cancelof
Job Applicant’s Agreement and Certification
“I certify that the information given by me in this application is true in all respects, and I agree that if the information given is found to be false in any way, it shall be considered sufficient cause for denial of employment or discharge. I authorize the use of any information in this application to verify my statements, and I authorize past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information.”

“I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between the company and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the company unless made in writing. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and that the company retains the same right.”

“I understand that if employed, policies, and rules which are issued are not conditions of employment and that the employer may revise policies or procedures, in whole or in part, at any time.”

"I understand that this application will be kept on file for six months from the date completed, after which time I would have to
reapply in accordance with established company procedures.”

In connection with my application for employment (including contract for services or volunteers), I understand that investigative background inquiries are to be made on me, which may include criminal, civil litigation, motor vehicle, and other reports. These reports may include information as to my character, work habits, performance, education and experience along with reasons for termination of employment from previous employers. Further, I understand that you will be requesting information from various Federal, State, and other agencies which maintain records concerning my past activities relating to my driving, criminal, civil and other experiences.

I authorize without reservation, any party or agency contacted to furnish the above mentioned information and release all parties involved from any liability and responsibility for doing so. I hereby consent to obtaining the above information from any of their licensed agents. This authorization and consent shall be valid in original, fax or copy form. I further authorize ongoing procurement of the reports mentioned above at any time during my employment, (contract or volunteering).

This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. Employers can only use E-Verify once you have accepted a job offer and completed the Form I-9.
I understand and agree

Voluntary Self–Identification of Disability Form
Why are you being asked to complete this form?

We are required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years.

Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:
- Autism
- Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS
- Blind or low vision
- Cancer
- Cardiovascular or heart disease
- Celiac disease
- Cerebral palsy
- Deaf or hard of hearing
- Depression or anxiety
- Diabetes
- Epilepsy
- Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome
- Intellectual disability
- Missing limbs or partially missing limbs
- Nervous system condition for example, migraine headaches, Parkinson’s disease, or Multiple sclerosis (MS)
- Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression
[i] Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.
Please check one of the boxes

Yes, I Have A Disability, Or Have A History/Record Of Having A DisabilityNo, I Don’t Have A Disability, Or A History/Record Of Having A DisabilityI Don’t Wish To Answer
Name

First NameLast Name
Date

MonthDayYear
Date
Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
[1] Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.
Should be Empty:

Application for Employment

Voluntary Identification Form

Voluntary Self–Identification of Disability Form