Position applying for
PERSONAL DATA
Name
Street
City
State
Zip
Home Telephone Number
Business Telephone Number
Cellular Telephone Number
Date you can start work
Salary Desired
Do you have a High School Diploma or GED?
Do you have a High School Diploma or GED?
Yes
No
Check all that you are willing to work
POSITION INFORMATION Check all that you are willing to work
Yes
No
Hours
Location
Select
Swing
Graveyard
Weekends
Authorized
Are you authorized to work in the U.S. on an unrestricted basis?
Yes
No
Convictions
Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.)
Yes
No
If yes, explain:
Can you perform these essential functions?
Can you perform these essential functions?
Yes
No
QUALIFICATIONS Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training.
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School Name
Degree
Area/City/State
School
School1
Degree1
Area/City/State1
School
School-2
Degree-2
Area/City/State-2
Other
other1
other2
other3
SPECIAL SKILLS List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.
special skills
REFERENCES Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don't have three professional references, then list personal, unrelated references.
Name
Address/City/State
Phone
Relationship
Name1
Address/City/State1
Phone1
Relationship1
Name2
Address/City/State2
Phone2
Relationship2
Name3
Address/City/State3
Phone3
Relationship3
WORK HISTORY Start with your present or most recent employment and work back. Use separate sheet if necessary. (INCLUDE PAID AND UNPAID POSITIONS)
Job title #1
Start Date
End Date
Company Name
Supervisor's Name
Phone Number
City
State
Zip
Duties
Reason of Leaving
Starting Salary
Ending Salary
May we contact your present employer?
May we contact your present employer?
Job title #2
Start Date
End Date
Company Name
Supervisor's Name
Phone Number
City
State
Zip
Duties
Reason of Leaving
Starting Salary
Ending Salary
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, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.
I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.
Date
Send
