Application for Employment
Our policy is to provide equal employment opportunity to all qualified person without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran status.
Date
Last name First name Middle name
Street Address
City State Zip Code
Telephone Social Security #
Position applied for
When can you start?
Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.) Yes No
Are you looking for full-time employment? Yes No
If no, what hours are you available?
Have you ever been convicted of a felony? (This will not necessarily affect your application.)
Yes No
If yes, please describe conditions.
_____________________________________________________________________________________
_____________________________________________________________________________________
Education
School Name and Location Year Major Degree
High School _________ ________
College _________ ________
College _________ ________
Post–College _________ ________
Other Training _________ ________
In addition to your work history, are there other skills, qualifications, or experience that we should consider?
______________________________________________________________________________________
______________________________________________________________________________________
Employment History (Start with most recent employer)
Company Name
Address Telephone
Date Started Starting Wage_ Starting Position
Date Ended Ending Wage_ Ending Position
Name of Supervisor
May we contact? Yes No
Responsibilities
______________________________________________________________________________________
Reason for leaving
Company Name
Address Telephone
Date Started Starting Wage_ Starting Position
Date Ended Ending Wage_ Ending Position
Name of Supervisor
May we contact? Yes No
Responsibilities
______________________________________________________________________________________
Reason for leaving
Company Name
Address Telephone
Date Started Starting Wage_ Starting Position
Date Ended Ending Wage_ Ending Position
Name of Supervisor
May we contact? Yes No
Responsibilities
______________________________________________________________________________________
Reason for leaving
Company Name
Address Telephone
Date Started Starting Wage_ Starting Position
Date Ended Ending Wage_ Ending Position
Name of Supervisor
May we contact? Yes No
Responsibilities
______________________________________________________________________________________
Reason for leaving
Attach additional information if necessary.
I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered suf-ficient cause for dismissal. This company is hereby authorized to make any investigations of my prior edu-cational and employment history.
I understand that employment at this company is "at will," which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not pro-hibited by stature. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing.
Signature Date _
