Application for Employment employment form Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran status. Name * Name First Name First Name Last Name Last Name Street Address * City * State * Zip * Phone * Position Applied For * Do you have a current Driver's License? * Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis (you may be required to provide documentation). * Yes No Are you looking for full-time employment? * Yes No Have you ever plead "guilty" or "no contest" to, or been convicted of a crime? * Yes No If "yes" to the above, please provide date(s) and details: Answering "Yes" to the above questions does not constitute an automatic bar to employment. Factors such as date of offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account. Employment History (Start with most recent employer). Company Name * Address * Telephone * Date Started * Starting Wage * Starting Position * Date Ended * Ending Wage * Ending Position * Name of Supervisor * May we contact? * Yes No Responsibilities * Reason for leaving * Company Name * Address * Telephone * Date Started * Starting Wage * Starting Position * Date Ended * Ending Wage * Ending Position * Name of Supervisor * May we contact? * Yes No Responsibilities * Reason for leaving * References Name * Phone * Years Known * Name * Phone * Years Known * Education High School * Yes No Name of High School * Year * College * Yes No Name of College * Year * I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history. I understand that employment at this company is "at will," which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing. I understand that the employer does not unlawfully discriminate in employment and no question on the application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state, or federal law. I certify that I have read and fully understand and accept all terms of the foregoing statement. Typed Signature * Date * I agree that the use of such electronic signature constitutes the legal equivalent of my manual signature for purposes of authenticating the signature to any filing for which it is provided. Captcha Submit If you are human, leave this field blank.
