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APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer

We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.

GENERAL

Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. Use blank paper if you do not have enough room on this application. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.

Job Applied for:

Today’s Date:

Type of employment desired:

Type of employment desired:

When could you start work?

Last Name

First Name

Middle Name

Telephone number

Present Street Address

City

State

Zip Code

Email address

Are you 18 years of age or older?

Are you 18 years of age or older?

Yes No

(If you are hired, you may be required to submit proof of age.) If hired, you will be required to furnish proof of your eligibility to work in the U.S.

Are you able to provide proof of U.S. citizenship?

Are you able to provide proof of U.S. citizenship?

Yes No

Have you ever been bonded?

Have you ever been bonded?

Yes No

Have you been convicted of a felony in the last seven (7) years?

Have you been convicted of a felony in the last seven (7) years?

Yes No

(Such conviction may be relevant if job related, but does not bar you from employment.) If Yes, please explain:

Have you ever applied here before?

Have you ever applied here before?

Yes No

If yes, when?

Have you ever applied here before?

Were you ever employed here?

Yes No

If employed, do you expect to be engaged in any additional business or employment outside of our job?

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?

For Driving Jobs Only: Do you have a valid driver’s license?

Yes No

Class of License State Licensed In Have you had your driver’s license suspended or revoked in the last 3 years?

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

EDUCATION
List Name And Address Of Schools

High School or GED:

Name

Address

Years Completed

Diploma/Degree Certificate

Subjects Studied

College or University:

Name

Address

Years Completed

Diploma/Degree Certificate

Subjects Studied

Vocational or Technical:

Name

Address

Years Completed

Diploma/Degree Certificate

Subjects Studied

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?

WORK HISTORY
List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. Note: A job offer may be contingent upon acceptable references from current and former employers.

Name Of Employer

Address City, State, Zip Code

Dates Of Employment (Mo/Yr): From To

To

Supervisor(S) Telephone

Job Title And Duties

Reason For Leaving

Name Of Employer

Address City, State, Zip Code

Dates Of Employment (Mo/Yr): From To

To

Supervisor(S) Telephone

Job Title And Duties

Reason For Leaving

Name Of Employer

Address City, State, Zip Code

Dates Of Employment (Mo/Yr): From To

To

Supervisor(S) Telephone

Job Title And Duties

Reason For Leaving

Name Of Employer

Address City, State, Zip Code

Dates Of Employment (Mo/Yr): From To

To

Supervisor(S) Telephone

Reason For Leaving

REFERENCES

Have you worked or attended school under any other names?

Have you worked or attended school under any other names?

Yes No

If yes, give names:

Are you presently employed?

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

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.

Name Address Phone

Name Address Phone

Name Address Phone

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SUBMITTING: 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.