| EMPLOYMENT APPLICATION | |
|---|---|
| This is a secure site in order to protect your personal information. | |
| PERSONAL INFORMATION | |
| First Name | |
| Middle Name | |
| Last Name | |
| Social Security Number | |
| Street Address | |
| City | |
| State | |
| Zip Code | |
| Phone Number | |
| Years you have lived at current address | |
| Have you used a name other than the one you listed? | Yes No |
| If so, previous name | |
| Dates previous name was used | |
| EMPLOYMENT DESIRED | |
| In making this application for employment, I understand that this particular application is for the below listed position only, and in no event will it be considered ACTIVE for longer than 30 days. |
| Position applying for | |
| Date you can start (MM/DD/YY) | |
| Salary desired | |
| Have you previously worked for us? | Yes No |
| If yes, when and where | |
| Are you currently employed | Yes No |
| Check all shifts you are interested in | Full Time Part Time Nights Overtime |
| If you checked part time, list time(s) you are available | |
| State the days and times which you cannot work |
| EDUCATION |
|---|
| List all education from secondary to university level. |
| Name | Location | No. of yrs | Diploma or degree | Subjects studied | |
|---|---|---|---|---|---|
| High School | |||||
| College | |||||
| Trade, Business, or Correspondence Schools |
|||||
| List machines or equipment you can operate. | |
| List any special skills. | |
| In the last five years, have you been convicted of a felony? | Yes No |
| If yes, describe in full (will not necessarily exclude you from consideration). | |
| List any friends or relatives working for us and state relationship. | |
| If the job required safety shoes, would you be able to purchase them before start date. (The company will reimburse you for part of the cost.) |
Yes No |
| Were you in the Armed Forces? | Yes No |
| If yes, what branch? | |
| Beginning date of duty. | |
| Ending date of duty. | |
| Rank at discharge. |
| FORMER EMPLOYERS | |
| List below your last six employers, starting with the last one. | |
| From MM/YY | To MM/YY | Name, Address and Phone No. of Employer | Salary | Position | Reason for leaving | Supervisor's name and phone | |
|---|---|---|---|---|---|---|---|
| Employer 1 | |||||||
| Employer 2 | |||||||
| Employer 3 | |||||||
| Employer 4 | |||||||
| Employer 5 | |||||||
| Employer 6 |
| May we contact the employers listed above? | Yes No |
| If not, indicate which one(s) you do not wish us to contact: | |
| Are there any other experiences, skills, or qualifications which you feel would especially qualify you to work for this company? |
| REFERENCES |
|---|
| Give the names of three persons not related to you, whom you have known at least one year. |
| Name | Address | Business | Phone No. | Yrs Acquainted | |
|---|---|---|---|---|---|
| Reference 1 | |||||
| Reference 2 | |||||
| Reference 3 |
| CONDITIONS: I authorize the company to verify all statements contained in this application for employment and
to make reference and background checks as its representatives deem necessary except as limited
above for present employer. You are hereby authorized to make any investigation of my personal
or employment history and my financial and credit record through any investigative consumer
agencies or bureaus of your choice. I also understand that an investigative consumer report may
be made whereby information is obtained through personal interviews with my neighbors, friends,
or others with whom I am acquainted. This inquiry includes information as to my character,
general reputation, personal characteristics and mode of living.
I understand that employment is contingent upon complying with the employment verification requirements of the Immigration Control and Reform Act. I certify that all of the statements I have made and all information provided in this application are true, and agree that my representation or omission of facts called for may result in cancellation of my application for employment or immediate dismissal. In consideration of my employment, I agree to conform to the rules and regulations of the company, and I understand that if I am employed by the company that my employment, regardless of the manner or duration of my compensation, will be for no definite term, and my employment and compensation can be terminated, with or without cause, and with or without notice at any time, for any reason, at the option of the company. I understand that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. |
| Signature | Date (MM/DD/YY) |