Job Applied for:
Today’s Date:
Type of employment you are seeking:	Select... Full-time Part-time Temporary
Employment hours of availability:	Select... Daytime Evening
When can you start work?
*Last Name:		*First Name:
Middle Name:
Present Street Address:
City:		State:
Zip:		*Phone:
Email:
Are you at least 18 years of age?: (If you are hired, you may be required to submit proof of age.)		Yes No
Social Security#:
If hired, can you furnish proof you are eligible to work in the U.S.?:		Yes No
Have you ever applied here before?	Yes No	If yes, when?
Were you ever employed here?	Yes No	If yes, when?
Have you ever been convicted of any law violation? Include any plea of “guilty” or “no contest.” Exclude minor traffic violations.)		Yes No
If yes, give details: (A conviction will not necessarily disqualify an applicant for employment.)
If employed, do you expect to be engaged in any additional business or employment outside of our job?		Yes No
If yes, give details:
For Driving Jobs Only: Do you have a valid driver’s license?		Yes No
Driver’s License Number:
Class of License:
State Licensed In:
Have you had your driver’s license suspended or revoked in the last 3 years?		Yes No
If yes, give details:
List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability or other protected status.):
Education
Name & Location of School Select Last Year Completed Major Course Diploma/Degree High School Select... 7 8 9 10 11 12 College/University Select... 1 2 3 4 More Select... Bachelors Masters Doctorate Other None College/University Select... 1 2 3 4 More Select... Bachelors Masters Doctorate Other None Business or Trade School
What skills or additional training do you have that relate to the job for which you are applying?
What machines or equipment can you operate that relate to the job for which you are applying?
Employment History
Please list chronologically, beginning with most recent experience.
Employer:		Address/City:
From (MM/YYYY):		To (MM/YYYY):
Supervisor:		Phone:
Salary:
Type of Work:
Reason for Leaving:
Employer:		Address/City:
From (MM/YYYY):		To (MM/YYYY):
Supervisor:		Phone:
Salary:
Type of Work:
Reason for Leaving:
Employer:		Address/City:
From (MM/YYYY):		To (MM/YYYY):
Supervisor:		Phone:
Salary:
Type of Work:
Reason for Leaving:
Have you worked or attended school under any other names?		Yes No
If yes, give names:
Are you presently employed?:		Yes No
If yes, whom do you suggest we contact?
Have you ever been fired from a job or asked to resign?:		Yes No
If yes, please explain?
Give three references, not relatives or former employers.
1) Name of Reference:
1) Address:
1) Phone:
2) Name of Reference:
2) Address:
2) Phone:
3) Name of Reference:
3)Address:
3) Phone:
Please read carefully before submitting your application I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENT OF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE. *Check this box to certify that you have read and accept the above statement.