Link - Application for Employment


Application For Employment							Click here for a pdf to print and mail or fax in.
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.
	Position(s) applied for

	How did you learn about us?
		Advertisement
		Employment Agency
		Relative
		Friend
		Inquiry
		Other

	First Name
	Middle Name
	Last Name
	Address
	City
	State
	Zip Code
	E-mail
	Telephone Number

	Best time to contact you at home is						AM	PM

	If you are under 18 years of age, can you provide required proof of eligibility to work?						Yes	No

	Have you ever filed an application with us before?						Yes	No
		If yes, give date

	Do any of your friends or relatives, other than spouse, work here?						Yes	No

	Are you currently employed?						Yes	No

	May we contact your present employer?						Yes	No

	Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?						Yes	No
		Proof of citizenship or immigration status will be required upon employment

	Date available for work

	What is your desired salary range?

	Are you available to work:				Full Time		Shift 1
							Shift 2
							Shift 3
					Part-Time		Mornings
							Afternoons
							Evenings
					Temporary

	Are you currently on "lay-off" status and subject to recall?						Yes	No

	Can you travel if a job requires it?						Yes	No

	Have you been convicted of a felony within the last five years?						Yes	No
		A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question.

		Name and Address of School	Course of Study		Years Completed		Diploma Degree
	Elementary School
	High School
	Undergraduate School
	Graduate Professional
	Other (Specify)

	Describe any specialized training, apprenticeship, skills and extra-curricular activities.


	Describe any job-related training received in the United States Military.


	Employment Experience
	Start with your recent or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.
	Employer				Dates Employed		Work Performed
	Address				From	To

	Telephone Number (s)				Hourly Rate/Salary
	Job Title				Start	Final

	Supervisor
	Reason For Leaving

	Employer				Dates Employed		Work Performed
	Address				From	To

	Telephone Number (s)				Hourly Rate/Salary
	Job Title				Start	Final

	Supervisor
	Reason For Leaving


	Employer				Dates Employed		Work Performed
	Address				From	To

	Telephone Number (s)				Hourly Rate/Salary
	Job Title				Start	Final

	Supervisor
	Reason For Leaving

	Additional Information
	Other Qualifications
	Summarize special job-related skills and qualifications acquired from employment or other experience.


	State any additional information you feel may be helpful to us in considering your application.


	Note to applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS FOR THE JOB FOR WHICH YOU ARE APPLYING.

	Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given.
							Yes	No

	References
	Name					Phone #
	Address

	Name					Phone #
	Address

	Name					Phone #
	Address

	Applicant's Statement
	I certify that answers given here 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 45 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 or by conduct unless such change is 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 rules and regulations of the employer.
	Signature of Applicant			Date








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