a copy of our Job application.

a copy of our Job application.
Employment Application
DESIRED POSITION:
DATE OF APPLICATION:
/
MM
/
DD
YYYY
PERSONAL INFORMATION
NAME:
LAST
ADDRESS:
FIRST
STREET
CONTACT INFORMATION: (
MIDDLE
APT
)
CITY/STATE
(
HOME TELEPHONE
ZIP
)
MOBILE TELEPHONE
EMAIL ADDRESS
Have you ever applied or worked here before?
YES
NO
Are you at least 18 years of age?
YES
NO
Are you legally eligible to work in the U.S.?
YES
NO
Do you have reliable transportation to and from work?
YES
NO
Are you able to perform the essential functions of the position for which
you are applying, either with or without reasonable accommodation?
YES
NO
List any friends or relatives who work here:
List any other names used or under which you have been known:
I am interested in:
FULL-TIME
These are the days
and hours I am
available to work:
PART-TIME
MONDAY
TUESDAY
WEDNESDAY
SEASONAL (Holiday/Summer)
THURSDAY
FRIDAY
SATURDAY
SUNDAY
1ST SHIFT
2ND SHIFT
EDUCATION
NAME AND LOCATION
GRADUATED?
MAJOR/SUBJECTS STUDIED
HIGH SCHOOL
COLLEGE/UNIVERSITY
SPECIALIZED TRAINING/
TRADE SCHOOL/ETC.
LICENSES/CERTIFICATES
Please list your areas of highest proficiency, special skills or other items that may contribute to your abilities in performing
the above mentioned position:
PREVIOUS EXPERIENCE
FORMER EMPLOYERS
LIST BELOW LAST THREE EMPLOYERS, STARTING WITH THE MOST RECENT:
DATES (MM/YYYY)
NAME AND ADDRESS OF EMPLOYER
SALARY
POSITION
REASON FOR LEAVING
FROM
TO
FROM
TO
FROM
TO
Have you served in the U.S Armed Forces? YES
NO
If YES, list which branch and dates you served:
ADDITIONAL INFORMATION:
Have you been convicted of or plead guilty to a felony or misdemeanor and/or have you been charged with a felony or
misdemeanor which is currently pending disposition? YES
NO
If YES, then state the nature of each such offense and the date of each such conviction, plea and/or pending charge:
* The fact that you have a conviction, entered a plea or currently have a pending charge that involves a felony or
misdemeanor does not automatically disqualify you from employment with the Company.
REFERENCES
LIST THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST TWO YEARS:
NAME
ADDRESS
TELEPHONE NUMBER
YEARS ACQUAINTED
I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE
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 COMPANY’S RULES AND REGULATIONS, 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 NOTICE, AT
ANY TIME 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
ANY AGREEMENT CONTRARY TO THE FOREGOING.
SIGNATURE:
DATE:
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