Application for Employment

First name*

Middle Name

Last name*

Street address*

City*

State/Region*

Postal Code*

Phone number*

Email*

Position Applied For

Salary or Hourly Wage Desired

Date Available to Begin Work*

Month/Day/Year

Are you 18 years of age or older?*

Are you currently employed?

If yes, may we contact your current employer?

Have you ever submitted an application and/or interviewed for employment with our company?

If yes, give month and year

Have you ever been employed with our company before?

If yes, give dates.

Are you legally eligible for employment in the United States?*

If you have had an opportunity to review a job description for the position for which you are applying, can you perform the essential functions of this job with or without reasonable accommodation? (Check N/A if you have not reviewed a job description)

Educational Background

Type of School*

Name and Location of School*

Start date*

Month/Day/Year

End date*

Month/Day/Year

# of Years Completed*

Course of Study/Major*

Level of Education Completed*

Degree*

GPA*

Type of School

Name and Location of School

Start date

Month/Day/Year

End date

Month/Day/Year

# of Years Completed

Course of Study/Major

Level of Education Completed

Degree

GPA

Type of School

Name and Location of School

Start date

Month/Day/Year

End date

Month/Day/Year

# of Years Completed

Course of Study/Major

Level of Education Completed

Degree

GPA

Skills

List any additional skills, training, and/or technical or professional knowledge that is relevant to the job for which you are applying:

List any certificates, licenses, or professional achievements that would support your qualifications for employment:

Drivers’ License Identification Number:

State of Issuance:

(Provide your driver's license ID number ONLY if it is a requirement of the position for which you are applying).

Employment History

Name of Employer #1

Phone Number

Address

City

State/Region

Postal Code

Employment Dates (from):

Month/Day/Year

Employment Dates (to):

Month/Day/Year

Starting Hourly Wage/Salary

Final Hourly Wage/Salary

Job Title

Name and Job Title of Supervisor

Brief description of job duties, responsibilities and significant accomplishments:

Reason for leaving:

Name of Employer #2

Phone Number

Address

City

State/Region

Postal Code

Employment Dates (from):

Month/Day/Year

Employment Dates (to):

Month/Day/Year

Starting Hourly Wage/Salary

Final Hourly Wage/Salary

Job Title

Name and Job Title of Supervisor

Brief description of job duties, responsibilities and significant accomplishments:

Reason for leaving:

Name of Employer #3

Phone Number

Address

City

State/Region

Postal Code

Employment Dates (from):

Month/Day/Year

Employment Dates (to):

Month/Day/Year

Starting Hourly Wage/Salary

Final Hourly Wage/Salary

Job Title

Name and Job Title of Supervisor

Brief description of job duties, responsibilities and significant accomplishments:

Reason for leaving:

References

List three references other than relatives or former supervisors:

Reference #1 Name/Occupation*

Address/City/State*

Phone Number*

Years Known*

Reference #2 Name/Occupation

Address/City/State

Phone Number

Years Known

Reference #3 Name/Occupation

Address/City/State

Phone Number

Years Known

Please read carefully and sign below

I hereby certify that all of the information I have provided on this Application for Employment Form is accurate and complete to the best of my knowledge. I understand that any misrepresentation or omission of facts will disqualify me from further consideration of employment, withdrawal of any offer of employment, or termination of employment, if hired.

I authorize verification of all of the information I have provided on this Application for Employment Form as well as any additional information needed to consider my application for employment. I authorize all previous employers, educational institutions, references, and other persons who have knowledge of me or my records to provide any and all information pertinent to my employment and release the same from any liability resulting from providing such information. I also release this company and its employees from all liability for any damage that may result from reliance on the information furnished.

If employed, I agree to abide by all policies, procedures, and rules of the company. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages or salary, be terminated by myself or the company at any time with or without cause or notice. I further understand that the policies, procedures, rules, and benefits contained in the employee handbook, benefit plans, and other written documents should not be considered an employment contract for any period of time.

Date*

Month/Day/Year

Signature of Applicant*

Resume

Please upload your resume in Microsoft Word or Adobe PDF format.

Resume