Application for Employment


We consider applicants for all positions without regard to race, color, creed, gender, national origin, age, disability, martial or veteran status, or any other legally protected status. We are an equal opportunity employer.



Position Applying for:




How Did You Learn About Us?


  Advertisement
  Friend
  Employment Agency
  None of the Above

NAME & ADDRESS:


First Name:     

Middle Initial:  

Last Name:     

Address:         

City:              

State:            

Zip Code:       


CONTACT INFORMATION:


Telephone Number:

Social Security Number(voluntary):



Best time to contact you at home is:   AM  PM



Have you ever filed an application with us before?
 Yes
 No

If Yes, please give date:


Are you currently employed:     Yes   No


Date available for work:


What is your desired salary range:


Are you available for work:
 Full-Time
 Part-Time

Please indicate:
 Swing Shift
 Overnight
 Weekends


Do you have a valid driver's license?
 Yes
 No


EDUCATION:


High School:
Address:
Course of Study:
No. of Years:
Degree or Diploma:


College:
Address:
Course of Study:
No. of Years:
Degree or Diploma:


Graduate:
Address:
Course of Study:
No. of Years:
Degree or Diploma:


Business or Trade:
Address:
Course of Study:
No. of Years:
Degree or Diploma:

WORK EXPERIENCE


**Current or most recent job first**

Employer: Dates: to
Address: Telephone Number:
Starting/Present Title: Hourly Rate: Starting:Ending:
Supervisor:    

Work Performed:

   

Reason for Leaving:

   

May we contact this employer:
 Yes
 No


Employer: Dates: to
Address: Telephone Number:
Starting/Present Title: Hourly Rate: Starting:Ending:
Supervisor:    

Work Performed:

   

Reason for Leaving:

   

May we contact this employer:
 Yes
 No


Employer: Dates: to
Address: Telephone Number:
Starting/Present Title: Hourly Rate: Starting:Ending:
Supervisor:    

Work Performed:

   

Reason for Leaving:

   

May we contact this employer:
 Yes
 No


Comments(Include explanation of any gaps in employment):

   

What types of equipment can you operate and any specialized skills(such as computer programs you can operate):

      

Describe any specialized training, skills and extra-curricular activities.(You may exclude any membership which would reveal gender, race, national origin, age ancestory, disability or other protected status).   

In this space, briefly set forth why you desire a position with this company and why you think you will make a valuable employee:



REFERENCES(not former employers or relatives):


Name:
Occupation:
Address:
Phone:

Name:
Occupation:
Address:
Phone:

Name:
Occupation:
Address:
Phone:


APPLICANT STATEMENT
I certify that the answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document unless such change specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all policies and procedures of the employer.

Name:      Date: