Employment Application

 AT-WILL EMPLOYMENT APPLICATION

 PLEASE FILL OUT ALL INFORMATION AND ELECTRONICALLY SIGN BELOW
THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, marital status, national origin, citizenship, disability, veteran status, or any other status protected under state and federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a medical examination, which may include providing body substance samples. This application will remain active for 180 days. 

PERSONAL INFORMATION 

 
 Name:      
   Last Name
 First Name
Middle Name
 Phone Number:
 
  Home
 Work
 Please list below your current address
   
         
Street City State Zip Since (Mo/Yr)

 EDUCATION

High School Attended:
     
 High School Name
City
County
State
Did you earn a Diploma?    
Undergraduate College Attended:
Undergraduate College City County State
Degree/Certificate/Diploma Earned:

 School Name
City
County
State
Degree/Certificate/Diploma Earned:  

 EMPLOYMENT INFORMATION

 
Position Applied for:
   Date you can start work:
 
Do you prefer:
   Can you work:
 
 
Please answer the following questions. When necessary, note question number and use extra paper to provide explanations:
1). Are you at least 18 years of age and legally eligible to work in United States?
2). Will you work overtime when necessary?
3). Have you ever filed an application with us before?
4). Are you on layoff and subject to recall?
5). Have you ever been discharged or asked to resign from a job?
6). Have you ever been convicted of or pleaded guilty to a felony or other crime?
7). Are you currently employed?
8). Have you served in the US Military?

EMPLOYMENT HISTORY

 
MAY WE CONTACT YOUR PRESENT EMPLOYER?
Please list below your last three employers beginning with the most recent:
 
Most Recent Employer




Employer Name City State Zip Phone
Position Held
From (Date)
To (Date)
Pay Rate
Supervisor Name
Reason for Leaving:
   


Next Most Recent Employer







Employer Name City State Zip Phone


Position Held
From (Date)
To (Date)
Pay Rate
Supervisor Name
Reason for Leaving:
       




Next Most Recent Employer





Employer Name City State Zip Phone




Position Held
From (Date)
To (Date)
Pay Rate
Supervisor Name
Reason for Leaving:

   

 JOB-RELATED SKILLS

 
Please answer the following questions:
1). Do you have a valid Driver's License?
2). Have you been convicted of or pleaded guilty to any traffic-related  offense within the last five years?
3). Have you had your driver's license suspended or revoked or had your driving privileges modified by a court or law?
4). Please list all states from which you hold or have held a driver's license?
Please use this space to list any special skills you may have that relates to the position applied for:
Please list personal references with telephone numbers: (Reference Name, Phone Number)
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02

03

APPLICANT'S CERTIFICATION AGREEMENT

 01 I authorize the investigation of all statements contained in this application and release from all liability any person or employers supplying such information, and I also release the company from all liability that might result from making the investigation.
 02 I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or any required documents) will be cause of denial of employment or immediate termination of employment, regardless of when or how discovered.
 03 I agree, if I am offered and accept position, to confirm to all existing and future Company rules and regulations and I understand that the Company reserves the right to change wages, hours and working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE AT-WILL, MEANING THAT EITHER PARTY CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.
 04 I understand that any employment offer is contingent upon my providing, within three (3) working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986.   
 05 I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.
 
sign here
 
Signature
Date