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Name:
Social Security Number:
Current Address:
Ex: 40227 Tigrone Blvd. Avon, NC 27915
Best Phone Number:
Position Applied for:
Type of work desired:
Please Select
Full-Time
Part-Time
Temporary
Date available to start:
-
Month
-
Day
Year
Date
GENERAL INFORMATION
Have you ever been employed by us?
Yes
No
If yes, please give dates of employment, position(s) held, and state your name while employed, if different from present name
Days available to work (please select all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Are you at least 18 years of age?
Yes
No
Do you have a valid driver’s license?
Yes
No
If we consider you as a candidate with our company, would you be willing to submit a background check?
Do you have any language abilities (such as reading or speaking a foreign language) that might help you perform the job(s) for which you are applying? If yes, please explain:
Skills Area
Word Processing Ability?
Yes
No
Computer Experience?
Yes
No
List the business machines, computers, and word processor you can operate:
Are you physically able to lift 50 lb. sacks on a continued, hour-by-hour, day-by-day basis?
Yes
No
Employment History
Employer
Name of Employer, Position Held, Dates of Employment
Employer Phone #
Name of Supervisor
Reason for Leaving?
Employer
Name of Employer, Position Held, Dates of Employment
Employer Phone #
Name of Supervisor
Reason for Leaving?
Employer
Name of Employer, Position Held, Dates of Employment
Employer Phone #
Name of Supervisor
Reason for Leaving?
Schools Attended
Highest Grade Completed?
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Associates
Bachelors
Graduate School
Masters
MBA
PHD
Did you Graduate?
Yes
No
Certifications / Diplomas / Degrees
Please list course of study
Technical, Vocational, Business or Military Training
Additional job-related seminars, short courses, workshops, or other educational experiences:
12. REFERENCES: List Three Individuals Who Are Not Former Employers Or Relatives
Please include their names, phone numbers, and occupations
13. Please list and describe any paid or unpaid activities, honors, experience, or training that might aid you in performing the job(s) for which you have applied, and have not been listed previously in this application. Omit any activities, honors, memberships or other items that tend to identify your race, sex, national origin, age, handicap or other personal traits.
14. Please add any additional information that you think may be relevant to a decision to hire you.
THIS APPLICATION FOR EMPLOYMENT WILL REMAIN ACTIVE FOR _____ WEEKS
Employer to fill this section out
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