Employment Application Form

Employment Application
Location

AntiochLindenhurstPaddock LakeFox LakeBurlingtonWoodstockMcHenry
Position of interest

Cashier/CounterDriverSandwich MakerPizza MakerOven CookAny PositionManagerAssistant ManagerOther
Where did you hear about the job opening?
Who were you referred by:
Name:*

First NameLast Name
Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*

Area CodePhone Number
E-mail Address:
Date Available

MonthDayYear
Date
Desired Salary
Do you know of any day off you will need in the next 3 months?

YesNo
If yes, what days:
Did anyone refer you to this job opening?
Are you a citizen of the United States?

YesNo
If no, are you authorized to work in the U.S.?

YesNo
Have you ever worked for this company?

YesNo
If yes, when?
If yes, explain
Education
High school
Address
From

MonthDayYear
Date
To

MonthDayYear
Date
Did you graduate?

YesNo
Degree
College
Address
From

MonthDayYear
Date
To

MonthDayYear
Date
Did you graduate?

YesNo
Degree
Other
Address
From

MonthDayYear
Date
To

MonthDayYear
Date
Did you graduate?

YesNo
Degree
References

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

First NameLast Name
Relationship
Company
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference 2
Name:*

First NameLast Name
Relationship
Company
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 3
Name:*

First NameLast Name
Relationship
Company
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Employment
Company
Phone
Address
Supervisor
Job Title
Responsibilities
From

MonthDayYear
Date
To

MonthDayYear
Date
May we contact your previous supervisor for a reference?

YesNo
Company
Phone
Address
Supervisor
Job Title
Responsibilities
From

MonthDayYear
Date
To

MonthDayYear
Date
May we contact your previous supervisor for a reference?

YesNo
Company
Phone
Address
Supervisor
Job Title
Responsibilities
From

MonthDayYear
Date
To

MonthDayYear
Date
May we contact your previous supervisor for a reference?

YesNo
Military Service
Branch
From

MonthDayYear
Date
To

MonthDayYear
Date
Rank at Discharge
Type of Discharge
If other than honorable, explain
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Sign
Date

MonthDayYear
Date
Should be Empty:

Employment Application

Education