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EMPLOYMENT APPLICATION

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Prospective employees will receive consideration without discrimination based on race, creed, color, sex, age, national origin, handicap, veteran status or any condition prescribed by state or local law.

PERSONAL INFORMATION

Last Name:

     First:    Middle:

Address:

 

City:

    State:   Zip Code:

 

Phone:

     Cell:   
     

Have you ever applied for employment with us before?

 Yes No

       If Yes:  Month & Year    Location: 

       Position Desired:   Pay Expected: 
   

Apart from absence for religious observance, are you available for full-time work?

Yes No

Will you work overtime if asked?

 Yes No

Are you legally eligible to work in the United States?

 Yes No
When will you be available to begin work?   


Have you ever been convicted of any crimes in the past ten years, including misdemeanors and summary offenses, which have been annulled, expunged?

 Yes No

If Yes, describe in full:


Have you ever been bonded? 


Yes No

If yes, with what employers?

Other special training skills (Languages, machine operation, etc.):
   
EDUCATION
Name & Location of School Number of Years Completed Major Course Graduated Yes/No? Diploma/Degree
         
High School
 		Yes No
College/University
 		Yes No
Graduate
 Yes No
   
EMPLOYMENT HISTORY
Please give accurate, complete full-time and part-time employment record.  Start with your present or most recent employer.
   
Company Name:       Telephone:

Address:

 

City:

    State:   Zip Code:

 
Employed:  From (mm/yyyy):         To (mm/yyyy):  
Name of Supervisor:   
Weekly Pay:   Start:        Last:  
Job Title and Work Description:
 		  
Reason For Leaving:  
Company Name:       Telephone:

Address:

 

City:

    State:   Zip Code:

 
Employed:  From (mm/yyyy):         To (mm/yyyy):  
Name of Supervisor:   
Weekly Pay:   Start:        Last:  
Job Title and Work Description:
 		  
Reason For Leaving:  
Company Name:       Telephone:

Address:

 

City:

    State:   Zip Code:

 
Employed:  From (mm/yyyy):         To (mm/yyyy):  
Name of Supervisor:   
Weekly Pay:   Start:        Last:  
Job Title and Work Description:
 		  
Reason For Leaving:  
Company Name:       Telephone:

Address:

 

City:

    State:   Zip Code:

 
Employed:  From (mm/yyyy):         To (mm/yyyy):  
Name of Supervisor:   
Weekly Pay:   Start:        Last:  
Job Title and Work Description:
 		  
Reason For Leaving:  


ADDITIONAL INFORMATION

Membership in professional and civic organizations, special accomplishments, awards, etc.
(Exclude those, which may disclose your race, color, religion, age or national origin)
 

 
 
   

Please read and understand this statement before signing your application:

The information I have provided in this Application for Employment is true, correct and complete. False, incomplete or misrepresented information of any kind, will be sufficient cause for my application to be rejected or, if discovered after I am employed, cause for immediate termination of my employment.

I authorize the employer to contact and obtain information about me from previous employers, educational institutions and “references” I provided, and any other party necessary to verify the accuracy of information I disclosed in this application, a related employment resume or a personal interview. To assist in the processing of my application, I waive all rights and claims I may otherwise have against the employer or its representatives, for seeking, and using information to evaluate my employment request and all other persons, corporations or organizations who provide information for this purpose.

This application is not an employment agreement. If I accept an offer of employment I understand the employer may terminate my employment at any time with or without cause and of the employer, has authority to enter into any employment agreement with terms contrary to the foregoing and then only in writing signed by such officer.


 Check this box to certify that you fully understand and accept all of the terms and conditions in the above statement.

 

   
   
 

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