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Job Application

To be considered for employment, this Application for Employment Form must be completed and the below agreement statement acknowledged. Each question must be answered in full, even if a resume is provided. If an answer is NO or NOT APPLICABLE, indicate such.

AN EQUAL OPPORTUNITY EMPLOYER: It is our policy to consider for employment and advancement in employment qualified individuals, in accordance with applicable laws, without regard to race, color, religion, gender, sexual orientation, national origin, age, marital status, ancestry, disability, arrest and court records, credit history, pregnancy, gender identity or expression, genetic information, domestic or sexual violence victims status, military or veteran’s status or any other classification protected under state or federal laws.

Please notify a company representative if you require a reasonable accommodation to participate in the application and/or interviewing process.


* denotes a required field

Personal Information
Legal Name:
Date:
Address:
Apt #:
City/State/Zip:
Telephone:
Alternate Number:
Position(s) Applied For:
Date Available:
E-Mail Address:  
Rate of Pay Expecting:
Hours Available:
Employment Record
Begin with current or most recent employer. Include any applicable temporary employment.
Name of Employer:
Supervisor:
Address:
City:
State:
Zip:
Phone:
Employment Dates


Position/Title and Duties
Reason for Leaving
Name of Employer:
Supervisor:
Address:
City:
State:
Zip:
Phone:
Employment Dates


Position/Title and Duties
Reason for Leaving
Name of Employer:
Supervisor:
Address:
City:
State:
Zip:
Phone:
Employment Dates


Position/Title and Duties
Reason for Leaving
May we request references from the above:
Has notice been given to present employer:
Were you ever terminated and/or asked to resign from any employment?
Other names by which you are known that may assist us in checking your work history:
Skills
Typing, Speed:
Professional License(s) / Certification(s):
Computer, System:
List any other special training or skills:
(e.g., machine operation, foreign language, etc.)
Education
High School
Name & Location
Highest Level Completed
Diploma/Degree
Major
GPA
College
Name & Location
Highest Level Completed
Diploma/Degree
Major
GPA
Technical School
Name & Location
Highest Level Completed
Diploma/Degree
Major
GPA
Graduate School
Name & Location
Highest Level Completed
Diploma/Degree
Major
GPA
References
Name
Telephone
Occupation
Relationship
Name
Telephone
Occupation
Relationship
Name
Telephone
Occupation
Relationship
If employment is offered, can you submit a birth certificate, social security card, certificate of United States Citizenship or other verification of your legal right to work in the United States?
Have you previously applied for a position with us?
If Yes:
Were you previously employed by us?
If Yes:
What prompted you to apply here?
Referral:
Please Read Carefully Before Submitting

"I hereby certify that the information contained in this application is correct to the best of my knowledge, and understand that any falsification, misrepresentation or failure to provide information on this application or related documents whenever discovered and in any detail whatsoever, are grounds for disqualification from further consideration and for dismissal from employment.

I understand that this is only an application for employment, and not a promise or guarantee that employment is or will be offered to me. I understand that no oral or written contract of employment is created or is intended to be created by this application or by any statements made in conjunction with any interview. If employed, I understand that my employment shall be "at-will." I understand that my employment and compensation is for no definite period of time and can be terminated with or without cause, and with or without notice, at any time, at the option of either the Company or myself. I agree to conform to the rules, regulation policies and procedures of the Company, as they may be changed at the Company's discretion from time to time. I further understand that the terms and conditions of employment can be changed at any time at the Company's sole discretion and no representative of the Company other than the President has any authority to enter into any agreement for employment for any specified period of time or in any way inconsistent with the above.

I understand that the Company supports a drug free workplace and that drug testing is a part of the employment process. I understand that as a condition of being considered for employment and before an offer of employment is effective, I will be required to submit to and pass pre-employment drug testing in accordance with the Company's policies. Applicants who fail to pass testing or who violate any part of the Company's drug testing policy will not be employed, i.e. no offer of employment shall be made, any offer of employment will be rescinded, or if I have already commenced work, I will be terminated.

If employed, I further understand that, depending on the Company's policies and the needs of the job, I may be required to complete a medical history form and may be required to be examined by a medical professional designated by the Company.

If employed, I agree to provide the required documentation to verify that I am lawfully authorized to work in the United States and any other documentation deemed necessary by the Company. Any failure to provide such documentation shall result in termination from employment.

If employed, I understand that I may be required to disclose any conviction of or plead of no contest to a felony or lesser included offense substantially related to the functions and responsibilities of my job. I further understand that a conviction may not necessarily disqualify me from employment.

I further authorize the Company to verify and investigate all information and references provided by me in this application and in conjunction with any interview, and I release the Company and any person or other company responding to any reference or information inquiry from any claims or liability on any information or opinion supplied."

 
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