Please answer all questions completely online or in your handwriting in ink and then sign the completed application. Resumes are not accepted in lieu of completion of this application. NOTE: This application was designed to use with several types of job positions. Some questions may not be completely applicable to the job position you are seeking; however, we ask that you answer all questions.
I. PERSONAL INFORMATION
Last Name
First
Middle
Date
Street Address
Home Phone
City
State
Zip
Cellular Phone
Have you ever been involuntarily terminated or requested to resign?
Yes
No
If "Yes" explain:
If hired, can you provide verification of your legal right to work in the United States?
Yes
No
Are you at least 18 years of age?
Yes
No
If required for the position, do you have a valid driver's license?
Yes
No
Have you ever worked under a different name?
Yes
No
If “Yes” name:
Are you able to perform the essential functions of the position as listed and described on the attached job description or as demonstrated by the company representative with or without a reasonable accommodation?
Yes
No
Have you ever been convicted of a crime?
(Exclude convictions that have been sealed, expunged or legally eradicated, and misdemeanor convictions for which probation was completed and the case was dismissed)
Yes
No
If "Yes" list offense, date and disposition of the case
(Convictions will not necessarily disqualify you for the position):
Do you have a non-compete agreement or are you subject to any restrictive covenant with any of your former employers?
Yes
No
If “Yes” please explain.
II. EMPLOYMENT INTERESTS
Position Desired
Date Available
Salary Desired
Would you be willing to work overtime?
Yes
No
Type of Employment Desired
Regular
Full-Time
Temporary
Part-Time
Days and hours available for work
How were you referred to our company?
Ad (Where)
Employee Referral (Name)
Agency (Name)
Other (Please specify)
Walk-in
III. EDUCATION INFORMATION
School Level
Name and Location of School
Course of Study
Choose last grade completed
Did you graduate?
Degree or Diploma
High School
1
2
3
4
Y
N
College/University
1
2
3
4
Y
N
Post Graduate
1
2
3
4
Y
N
Business/Trade Technical
1
2
3
4
Y
N
IV. SKILLS - If Applicable for Position for Which You Are Applying
Typing speed
wpm
10 key by Touch
Yes
No
Foreign Languages (indicate proficiency to speak, read and write)
PC Skills (Indicate software used)
Other Skills
Do you have any experience, training, qualifications or special skills that you think make you especially suited for work at this company? (Explain)
NOTICE TO APPLICANTS:
This employer complies with the Americans with Disabilities Act of 1990. During the interview process, you may be asked questions concerning your ability to perform job-related functions. If you are given a conditional offer of employment, you may be required to complete a post-job offer medical history questionnaire and/or undergo a medical examination. If required, all entering employees in the same job category will be subject to the same medical questionnaire and/or examination and all information will be kept confidential and in separate files.
V. EMPLOYMENT INFORMATION (start with current or most recent employer). Account for all time periods including unemployment, self-employment and military service. (Attach separate paper(s), if necessary.)
1
Company Name
Phone
From Mo./Yr.
To Mo./Yr.
Street Address
City
State
Zip
Starting Pay
Ending Pay
Job Title
Duties
Reason for leaving
Supervisor name
May we contact this employer?
Yes
No
2
Company Name
Phone
From Mo./Yr.
To Mo./Yr.
Street Address
City
State
Zip
Starting Pay
Ending Pay
Job Title
Duties
Reason for leaving
Supervisor name
May we contact this employer?
Yes
No
3
Company Name
Phone
From Mo./Yr.
To Mo./Yr.
Street Address
City
State
Zip
Starting Pay
Ending Pay
Job Title
Duties
Reason for leaving
Supervisor name
May we contact this employer?
Yes
No
4
Company Name
Phone
From Mo./Yr.
To Mo./Yr.
Street Address
City
State
Zip
Starting Pay
Ending Pay
Job Title
Duties
Reason for leaving
Supervisor name
May we contact this employer?
Yes
No
VI. ACKNOWLEDGEMENT
Please read carefully, check to acknowledge each paragraph, and check below to agree
The contents of any employee handbook or personnel manuals, as well as other Employer policies and practices, are subject to change or modification by the Employer, solely at its discretion, without notice. I also understand that no supervisor or other official of the Employer (except its President, in writing) has the authority to enter into any agreement with me or to make any agreement contrary to the foregoing.
Check to acknowledge
I authorize any person, school, current employer (except as expressly noted), past employer(s), and organizations named in this application form (and accompanying resume or other documentation, if any) to provide the Company with relevant information and opinion, personal or otherwise, that may be useful in making a hiring decision. I release all parties from all liability for any damage that may result from furnishing information and opinion to you. Additionally, I understand that the company may conduct a background check.
Check to acknowledge
In consideration of employment, I agree to obey the rules and standards of the Company. I understand that nothing contained in this application or in the interview process is intended to create a contract between the Company and myself for either employment or for the providing of any benefits. I agree that my employment is at-will and the terms of employment may be changed with or without cause, with or without notice, including but not limited to termination, demotion, promotion, transfer, compensation, benefits, duties and location of work, at any time, for any reason, at the option of myself or the Company. This constitutes my entire agreement with the Company with regard to the length of my employment.
Check to acknowledge
I understand that as a condition of employment I may be required to take a post-offer/pre-employment alcohol/drug test. I further understand that, if management suspects that I am unable to perform my job without endangering others or myself at any time during my employment, I may be required to take an alcohol/drug test.
Check to acknowledge
I am able to perform the essential functions of the position with or without a reasonable accommodation.
Check to acknowledge
I understand that all offers of employment are conditioned upon my providing satisfactory documentary proof of my identity and legal right to work in the United States.
Check to acknowledge
I hereby acknowledge that I have read the above statements and understand them. I certify that I, the undersigned applicant, have personally completed this application. I declare that the facts contained in the application (or any resume or other documents submitted) are true and complete to the best of my knowledge. I understand that any misrepresentations or omissions will disqualify me from further consideration for employment, and will result in my dismissal from employment, if discovered at a later date.
Check to acknowledge
This application will remain active for ninety (90) days. Any applicant wishing to be considered for employment beyond ninety (90) days should reapply.
Check to acknowledge
By checking here, I am digitally signing this application
Date:
This employer is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, religion, national origin, disability, veteran status, citizenship status, or marital status. We assure you that your opportunity for employment with this employer depends solely upon your qualifications.
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