APPLICATION FOR EMPLOYMENT (CA)

We appreciate your interest in Company. Company is an equal employment opportunity employer. The Company’s policy is not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Company also prohibits harassment of applicants or employees based on any of these protected categories. It is also Company’s policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions.

Applicants with disabilities may be entitled to reasonable accommodation under the Americans with Disabilities Act and certain state or local laws. A reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity without imposing undue hardship on the company. Please inform the company’s personnel representative if you need assistance completing this application or to otherwise participate in the application process.

Your application will be active for 30 days. If you are not hired during that time period, but wish to continue to be considered for available positions, you must complete a new application.

Note to Applicants: Smoking is prohibited in all indoor areas of Company unless designated smoking areas have been established by a particular location in accordance with applicable state and local law.

Date

Name

First NameMiddle NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone Number

Area CodePhone Number

Work Phone Number

Area CodePhone Number

Position Applying For

Expecteed salaary/hourly range:

Applying for:

Are you at least 18 years old?

Minimum Salary Desired

Date Available for Work

Minimum Salary Desired

Are you available to work overtime as needed?

If yes, are you available weekdays?

If yes, are you available weekends?

Have you ever used any other name(s) which is (are) necessary for us to know in order for us to verify your employment or educational record?

If yes, pleaseprovide the other name(s):

Have you previously worked for or applied for a position with this Company, in any of our locations either as an employee or through an employment agency?

If yes, please explain when

Are you related to or in a close personal relationship with anyone now employed at this Company? (An answer of “Yes” will not automatically disqualify you from the position for which you are applying.)

If yes, state name(s

Are you legally authorized to work in the United States

Will you now or in the future require sponsorship for employment visa status (e.g.H-1B status)? (if hired, Verification will be required consistent with federal law)

How did you learnabout us?

Other

1. Company Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Supervisor Name

First NameLast Name

Supervisor Phone Number

Area CodePhone Number

Job Title

Work Responsibilities

Start Employed

Date

End Employment

Date

Reason for Leaving:

2. Company Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Supervisor Name

First NameLast Name

Supervisor Phone Number

Area CodePhone Number

Job Title

Work Responsibilities

Start Employed

Date

End Employment

Date

Reason for Leaving:

3. Company Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Supervisor Name

First NameLast Name

Supervisor Phone Number

Area CodePhone Number

Job Title

Work Responsibilities

Start Employed

Date

End Employment

Date

Reason for Leaving:

All employers including your current emplyer may be contacted to verify the information you provided. May we contact your current employer prior to any offer of employment?

During the past 7 years, have you ever been discharged, suspended, or asked to resign from any position?

For Purposes of verifying information on this application, have you ever worked or attended school under a differnt name at any of the orginizations you have listed?

1st References, provide name, occupation, phone, address and years known and capacity

2nd References, provide name, occupation, phone, address and years known and capacity

3rd References, provide name, occupation, phone, address and years known and capacity

Graduate (Please include name, street, city, state and zip code for each school)

College (Please include name, street, city, state and zip code for each school)

High School (Please include name, street, city, state and zip code for each school)

Business/Trade/Technical (Please include name, street, city, state and zip code for each school)

Please summarize your job-related skills and qualifications:

If hired can you provide a valid Drivers license? (if hired, you may be required to provide evidence of insurance or insurability)

Emergency Contact person:

Phone number of emergency contact:

I certify that all of the information furnished on this application and during the application process is true, complete and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts called for may result in refusal to hire or, if hired, may result in my dismissal at any time regardless of when the false answer or omissions are discovered.

Other

I recognize that this employment application is not an offer of employment. I agree that if I am hired by the Company, I will be an at-will employee, meaning that either the Company or I may end the employment relationship at any time with or without cause or notice. I understand that only authorized representatives with explicit authority to enter into agreements, and no manager, supervisor, or other non-authorize representative of the Company, has authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the at-will employment relationship, and with respect to any agreement entered into by the explicitly authorized representative, any such agreements must be in writing and signed by the explicitly authorized representative and by me or my authorized representative. You may contact human resources to inquire as to who the explicitly authorized representative is.

Other

I further understand and agree that, except for my at-will employment status, if hired, my wages, hours, working conditions, job assignment(s), and compensation rate(s) will be subject to change by the Company.

Other

I understand that if I am offered employment, I may be required to sign anon-solicitation and non-disclosure agreement, as a condition of the employment.

Other

I understand that the Company may share the information contained in this application with other Company employees for employment and administrative purposes and hereby consent to such transfer.

Other

I hereby authorize, to the extent allowed by applicable federal state and local laws, the Company to conduct its own investigation of my references, employment history and education and, further, authorize the references and prior employers I have listed to disclose to the Company information related to my employment history and qualifications for the position for which I am applying, without giving me prior notice of such disclosure

Other

I understand and expressly agree that if employed by the Company, storage areas provided for me (locker, desk, etc.) are open to investigation by the Company without prior notice to me.

Other

I agree to undergo a pre-employment physical examination consistent with federal and state law.

Other

I agree to submit to legally permissible drug testing upon an offer of employment from the Company and prior to starting work. I agree that any offer of employment is contingent upon my receiving a negative test result.

Other

I certify that, if employeed, my employment with the company will not conflict with, or result in the violation of, breach of, or default under, any contract, agreement, or understanding that i am a party to or am bound by, other than those I have disclosed in this application, if any:

Other

I agree that, if emplyed, i will report to my supervisor, a representative of HR, or other members of managment., if I am ever harassed by someone in the company or if I ever become aware of any unethical behavior by any employee.

Other

I wave my rights under California Civil Code 1786.53 to recieve a copy of any public records obtained by the Company to evaluate my application:

Other

I understand that the Comapny my not ask or require applicants to disclose past salary, wages or other compensation.

Other

Please verify that you are human

Date

Signature

APPLICATION FOR EMPLOYMENT (CA)

SUBMISSION OF RESUME:

G E N E R A L I NF O R M A T I O N

P E R M I S S I O N T O W O R K

R E F E R R A L I N F O R M A T I O N

W O R K E X P E R I E N C E

BACKGROUND INFORMATION

P R O F E S S I O N A L R E F E R E N C E S

E D U C A T I O N & T R A I N I N G

JOB-RELATED SKILLS AND QUALIFICATIONS

ADDITIONAL EMPLOYMENT INQUIRIES

A P P L I CA N T ’S S T A T E M E N T & A C K N O W L E D G M E N T

A P P L I C A N T ’S S T A T E M E N T & A C K N O W L E D G M E N T (continued)