Empoyment Application
Position Applied For:
Date:
Name
Address
City, State and Zip
Phone Number
If employed you will be required to submit proof of your legal right to work in the United States
If under 18 years of age, can you, after employment, submit a work permit? Yes No
Are you currently employed? Yes No
May we contact your present employer? Yes No
On what date would you be available for work?
Are you available to work? Full Time Part Time Overtime Weekends
Are you available to travel? Yes No
Have you ever been convicted of a felony? Yes No
If yes, please explain:
Conviction will not necessarily disqualify an applicant from employment
Have you ever had any job-related training in the United States Military? Yes No
If yes, please explain:
References
Give the name, address and telephone number of three references who are not related to you and are not previous employers we can contact

 

Education
SchoolName and Address of SchoolCourse of StudyNo. of Years CompletedDiploma/Degree
High School
Undergraduate College
Graduate/Professional
Other (Specify)

Work Experience
Start with your present 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 EmployeedWork Performed
Address From:
To:
Telephone Number
Starting/Present Job Title Hourly Rate/Salary
Supervisor Starting:
Final:
Reason for Leaving May We Contact: Yes    No
Employer Dates EmployeedWork Performed
Address From:
To:
Telephone Number
Starting/Present Job Title Hourly Rate/Salary
Supervisor Starting:
Final:
Reason for Leaving May We Contact: Yes    No
Employer Dates EmployeedWork Performed
Address From:
To:
Telephone Number
Starting/Present Job Title Hourly Rate/Salary
Supervisor Starting:
Final:
Reason for Leaving May We Contact: Yes    No
Employer Dates EmployeedWork Performed
Address From:
To:
Telephone Number
Starting/Present Job Title Hourly Rate/Salary
Supervisor Starting:
Final:
Reason for Leaving May We Contact: Yes    No
Comments: Include any explanation of any gaps in employment.
Decribe any specialized training, apprenticeships, skills and extra-curricular activies.
Describe any job-realted training recieved in the United States Military.
List professional, trade, business or civice activities and offices held.
Additional Information/Other Qualifications

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN-INFORMED ABOUT THE REQUIREMENTS OF 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

Applicant's Statement

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving to 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 lime 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 (Initials) Date: