Application for Employment

Position Applying For*

Full Legal Name*

Address (Street, City, State, Zip)*

Telephone (Include Area Code)*

Email*

Date Available for Employment*

MonthDayYear

Do you meet state minimum age for employment?*

YesNo

If employed and under 18, can you furnish a work permit?

YesNo

Have you ever been employed by Coastal Equipment?*

YesNo

If yes, when?

Do you have any relatives employed by Coastal Equipment?*

YesNo

If yes, who?

Are you employed now? *

YesNo

If yes, please give reason for desired change

May we contact your present and former employers?*

YesYes, but not my present employerNo

Are you prevented from lawfully becoming employed in this country because of VISA or immigration status?*

YesNo

Have you had a name change?*

YesNo

If yes, provide previous name

Do you have any potential conflict of interest in working for Coastal Equipment Corp?*

YesNo

If yes, please explain

Do you understand the importance of keeping employer information confidential?*

YesNo

Type of work desired:*

Do you have a valid driver's license?*

YesNo

Driver's License Number

Driver's License State

ex. VA, NC, etc.

Can you perform the essential functions of the job(s) for which you are applying?*

YesNo

If no, please explain

Are you available to work*

Full-timePart-timeOver-time

Have you been convicted of a crime/felony? (please note that a "Yes" answer will not bar you from consideration for employment)*

YesNo

If yes, please explain

Emergency Contact Name*

Emergency Contact Relationship*

Emergency Contact Phone Number*

Emergency Contact Address*

High School (School Name, City, State)*

University / College / Technical School (School Name, City, State)

Major(s), Minor(s)

Graduate School (School Name, City, State)

Course of Study

Special Skills, Qualifications, Certifications and Considerations*

Reference 1 - Name*

Reference 1 - Occupation / Relationship*

Reference 1 - Years Known*

Reference 1 - Phone Number*

Reference 2 - Name*

Reference 2 - Occupation / Relationship*

Reference 2 - Years Known*

Reference 2 - Phone Number*

Reference 3 - Name*

Reference 3 - Occupation / Relationship*

Reference 3 - Years Known*

Reference 3 - Phone Number*

Employer / Company*

Supervisor Name*

Your Job Position*

Employer Address*

Employer Phone Number*

Employment Dates (please share Start - End with Month/Year)*

Pay / Salary (please share Start and End Pay)*

Duties*

What did you like most about your job?*

What is your reason for leaving your job?*

Employer / Company 2

Supervisor Name 2

Your Job Position 2

Employer Address 2

Employer Phone Number 2

Employment Dates (please share Start - End with Month/Year) 2

Pay / Salary (please share Start and End Pay) 2

Duties 2

What did you like most about your job? 2

What is your reason for leaving your job? 2

Employer / Company 3

Supervisor Name 3

Your Job Position 3

Employer Address 3

Employer Phone Number 3

Employment Dates (please share Start - End with Month/Year) 3

Pay / Salary (please share Start and End Pay) 3

Duties 3

What did you like most about your job? 3

What is your reason for leaving your job? 3

Please list any additional employers here

Please upload a copy of your resume

I certify that all answers and statements I have made on this application (and resume or other supplementary materials) are true and complete without omissions. By signing below, I authorize Coastal Equipment Corp. to investigate all statements contained in this employment application as they may deem necessary in arriving at an employment decision. I understand that if I am employed any false information provided by me, no matter when discovered, may be sufficient cause for dismissal. I authorize any of the persons or organizations named in this application to give you complete information and records regarding my employment, education, character and qualifications. Employment is at will and can be terminated by the employer at any time. Applicant’s signature gives employer consent to check references, verify information & obtain reports from consumer reporting agencies. Applicant agrees that by signing the form, he or she will hold prospective employer harmless for any result of reference check. Employment is subject to passing a drug test.

If hired, I will be responsible for familiarizing myself with all rules and regulations of Coastal Equipment Corp. as they presently exist or are later modified. If hired, I understand my employment can be terminated, at the discretion of Coastal Equipment Corp. or at my option, without notice, at any time and for any reason. All employees are hired on a 90 day probation period.

I also understand that no representative of Coastal Equipment Corp. has any authority to enter into any employment agreement for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment, except as specifically stated in a current written agreement signed by the President.

I understand this application is not an offer of employment and no promises or representations of employment have been made to me at this time.

I have read, understand, and agree with the above.

Full Name*

Signature*

Date*

MonthDayYear

This application is valid for only ninety (90) days from the date I signed. If you want to be considered for job openings more than ninety (90) days from the date signed, you will need to submit a new application.

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis, including race, creed, color, age, sex, religion or national origin.

Application for Employment

Employment Section

Education Section

References Section

Employment Experience

Resume

Signature Section