Position applied for Application Date
Name
Middle Name
Last Name
Address
City
State / Province
Postal / Zip Code
Home Phone
Cellular/Other
Email
Shift preferred
Expected Pay
On what date would you be available for work?
If necessary, best time to call you is:
Preferred Contact Method
How were you referred to our Company?
If yes, please give date(s) and position(s):
If yes, please give dates:
Please provide your driver’s license number if driving is required for this job.
State
If yes, please explain:
If yes, please provide date(s) and details:
Employment Experience
Employer
Contact Name
Email
Address
Phone Number
Supervisor
Job Title
Date Employed: From
Date Employed: To
Hourly Rate/Salary:
Hourly Rate/Salary:
Work Performed
Reason for leaving:
What did you like most about your position?
What were the things you liked least about the position?
Employer
Contact Name
Email
Address
Phone Number
Supervisor
Job Title
Date Employed: From
Date Employed: To
Hourly Rate/Salary:
Hourly Rate/Salary:
Work Performed
Reason for leaving:
What did you like most about your position?
What were the things you liked least about the position?
Employer
Contact Name
Email
Address
Phone Number
Supervisor
Job Title
Date Employed: From
Date Employed: To
Hourly Rate/Salary:
Hourly Rate/Salary:
Work Performed
Reason for leaving:
What did you like most about your position?
What were the things you liked least about the position?
Explain any gaps in your employment, other than those due to personal illness, injury, or disability.
If yes, please explain:
Education Background
High School:
Location:
Course of study:
Degree or diploma:
College:
Location:
Course of study:
Degree or diploma:
Graduate School:
Location:
Course of study:
Degree or diploma:
Vocational Training/Other:
Location:
Course of study:
Degree or diploma:
Continuing Education:
Special Training of Skills
Languages, machine operation, etc., that would be of benefit in the job for which you are applying.
Professional References
Name
Title
Telephone
Email
Years Known
Relationship to you
Name
Title
Telephone
Email
Years Known
Relationship to you
Name
Title
Telephone
Email
Years Known
Relationship to you
Applicant Statement
I certify that all the information submitted by me on this application is true and complete, and I understand that if any false or misleading information, omissions or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any time. If hired, I agree to conform to the Company’s rules and regulations, and I understand that these rules and/or the employee handbook do not form a contract of employment either express or implied, and I agree that my employment and compensation can be terminated, with or without cause and with or without notice, at any time, at either my or the Company’s option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause and with or without notice, at any time by the Company. I understand that no Company representative, other than its Board, and then only when in writing and signed by the Board, has any authority to enter into any agreement for employment for any specific period, or to make any agreement contrary to the forgoing. I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, résumé, or job interview. I hereby waive all rights and claims I may have regarding the employer, its agents, employees, or representatives for seeking, gathering, and using truthful and no defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. I also understand that, if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States as required by federal immigration laws. This Company does not tolerate unlawful discrimination or harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. No question on this application issued to limit or exclude an applicant from employment consideration on any basis prohibited by applicable federal, state, or local law.
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