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Employment Application

Instructions: It is the policy of the company to provide equal opportunity with regard to all terms and conditions
of employment. The company complies with federal and state laws prohibiting discrimination on the basis of race, color, religion, creed, national origin, disability, veteran status, age or any other protected characteristic.

Name:
Phone:
Address:
City:
Zip:
Email Address:
Position applied for:
Expected Pay:
Would you accept full-time work?:  Yes     No
Would you accept part-time work?: Yes     No
On What date would you be available for work?

Have you been employed here before?:  Yes     No
Dates:

If you are under 18 years old, can you provide a work permit if required?
Yes     No
Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accomodation? )
Yes     No I Need more information about the job's "essential functions" to respond
This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accomodation, or whether accomodation is necessary. These issues may be addressed at a later date to the extent permitted by law.
 
Please explain any gaps in your employment, other than those due to personal illness, injury or disability:
Have you ever been fired or asked to resign from a job?
Yes     No

If yes, please explain:
Please list any special training or skills you have that would be of benefit in the job for which you are applying. ie: Languages, machine operations, etc.
Are you legally eligible for employment in the United States?
Yes     No

If yes, proof is required if hired.

Employment History

Employer 1:
Employer Name:
Phone:
Address:
City:
Zip:
Job Title:
Supervisor:
May we contact this employer? Yes     No

Dates employed:
From:         To:

Hourly rate/salary:
Starting: Final:


Work Performed:
Reason for leaving:

Employer 2:
Employer 2 Name:
Phone 2:
Address 2:
City 2:
Zip:
Job Title:
Supervisor:
May we contact this employer? Yes     No

Dates employed:
From:         To:

Hourly rate/salary:
Starting: Final:


Work Performed:
Reason for leaving:

Employer 3:
Employer 3 Name:
Phone 3:
Address 3:
City 3:
Zip:
Job Title:
Supervisor:
May we contact this employer? Yes     No

Dates employed:
From:         To:

Hourly rate/salary:
Starting: Final:


Work Performed:
Reason for leaving:

Employer 4:
Employer 4 Name:
Phone 4:
Address 4:
City:
Zip:
Job Title:
Supervisor:
May we contact this employer? Yes     No

Dates employed:
From:         To:

Hourly rate/salary:
Starting: Final:


Work Performed:
Reason for leaving:
 

Educational Background

Grammar School:

Name of school:
Location:
Course of Study:
Did you graduate?
Yes No
Years Completed:
Degree or Diploma?
 

High School:

Name of school:
Location:
Course of Study:
Did you graduate?
Yes No
Years Completed:
Degree or Diploma?
 

College:

Name of school:
Location:
Course of Study:
Did you graduate?
Yes No
Years Completed:
Degree or Diploma?
 

Graduate School:

Name of school:
Location:
Course of Study:
Did you graduate?
Yes No
Years Completed:
Degree or Diploma?

Vocational Training - Other:

Name of school:
Location:
Course of Study:
Did you graduate?
Yes No
Years Completed:
Degree or Diploma?

Continuing Education:


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.

In consideration of my employment, I agree to conform to the eompany's rules and regulations, and I understand that these rules or the employee handbook do not form a contract of employment either expressed 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 employement may be changed, with or without cause and with or without notification by the company. I understand that no company representative, other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make agreement contrary to the foregoing.