Employment Application

Applicant Instructions

Incomplete applications will not be processed. This application will be retained for one year from time of reciept. Any applicant wishing to be considered beyond this time period should submit another application.

Please note. This application is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all questions completely and accurately. False or misleading statements on this form are grounds for terminating the application process, or, if discovered after employment, terminating employment. Additional testing of job-related skills or for the presence of illegal drugs may be required prior to employment.

 
 Applicant Information
  First Name *
  Middle Initial
  Last Name *
  Suffix
  Address *
  City *
  ST *
  Zip Code *
  Home Telephone
  Daytime Telephone
  Email Address
 
 Position Information
  Which position are you interested in?
  Comments
  Desired Salary
  Willing to relocate? Yes  No
  Full-Time or Part-Time employment? Full-time  Part-time
  If Part-Time, how many hours per week & what days of the week are you available?
  What date are you available to start?
 
 Citizenship Information
  Are you prevented from being lawfully employed in this country due to a Visa or immigration status? Yes  No
 
 Education Information
  High School Name
  City
  ST
  Receive High School Diploma or GED? Yes  No
  College/University
  City
  ST
  How many years of College have you completed?
  What is/was your course of study?
  What was your graduation date/projected graduation date?
  Please list all other education:
 
 Job Related Skills
  List any languages other than English that you speak fluently:
  Mark all skills that apply: Word Processing
10 Key Adding Machine
Typing WPM 
  List all knowledge of computer programs:
  List any other skills:
  List any licenses or certifications you have that you feel would be of value to this job or company
 
 Security
  Have you ever been bonded in prior employment? Yes  No
  Have you ever been convicted of a misdemeanor or a felony? Yes  No If Yes, please explain 
 
 Background Authorization
  If I am interviewed and accept employment, I agree to allow company to investigate and verify my background including previous employment. Yes  No
 
 Employment Experience
  Please go back 5 years, listing your most recent employer first. Include any gaps in employment and state the reason for no employment during that period.
  Employer
  Address
  City
  ST
  Zip Code
  Phone
  Job Title
  Supervisor
  Start Date
  End Date
  Starting Salary/Hourly Wage
  Ending Salary/Hourly Wage
  Reason for Leaving
  Employer
  Address
  City
  ST
  Zip Code
  Phone Number
  Job Title
  Supervisor
  Start Date
  End Date
  Starting Salary/Hourly Wage
  Ending Salary/Hourly Wage
  Reason For Leaving
  Employer
  Address
  City
  ST
  Zip Code
  Phone Number
  Job Title
  Supervisor
  Start Date
  End Date
  Starting Salary/Hourly Wage
  Ending Salary/Hourly Wage
  Reason for Leaving
 
 References
  Include only individuals familiar with your work ability. Do not include relatives. Please do not include individuals to whom you directly reported or supervised in the last five years.
  Name, Address, Phone: # Years Known Relationship
1.
2.
3.
  * indicates required fields
 
I hereby certify that I have a genuine interest in being hired and that all of the foregoing statements are true and correct. I agree to assume a continuing responsibility to disclose additional or new information, called for by this Employment Application, but known to me only after this Application was completed, and understand that my failure to make such a disclosure, and that falsification of any of the information given herein, on any employment form or in any interview, are grounds for immediate termination, regardless of when such failure or falsification may be discovered.

I also understand that my employment may be terminated at any time, with or without cause, without liability to me for salary, wages, or other benefits except as may have been earned up to date of the termination of services.
 
 

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