Application for Employment

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.

Date

Month

Day

Year

Position applied for

Full name, including middle initial

Address (include city, state, and zip)

Phone

Birthday

Month

Day

Year

Social Security Number

Date available for work

Month

Day

Year

Email

Are you able to meet our requirement of 18 years of age?

Yes

No

Have you been employed here before?

Yes

No

If yes, give date(s)

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

If no, what hours are you available?

Are you able to meet the attendance requirements of the position?

Yes

No

Have you ever been convicted of a felony?

Yes

No

If yes, please describe conditions.

Driver's License Number

State

Driver's License Expiration Date

Month

Day

Year

Education

Name of High School(s) and years attended

Name of College(s) and years attended (type "none" if not applicable)

College Major(s) (type "none" if not applicable)

College Degree(s) (type "none" if not applicable)

Post college education or other training (type "none" if not applicable)

Employment History (start with most recent employer)

Company #1: Name , address, and phone number

How long did you work for the company? (Please be specific with dates)

Please list your starting wage and ending wage.

Please list your starting position and your ending position.

Name of Supervisor

May we contact?

Yes

No

Please list what your job responsibilities were, and your reason for leaving.

Company #2: Name , address, and phone number

How long did you work for the company? (Please be specific with dates)

Please list your starting wage and ending wage.

Please list your starting position and your ending position.

Name of Supervisor

May we contact?

Yes

No

Please list what your job responsibilities were, and your reason for leaving.

Company #3: Name , address, and phone number

How long did you work for the company? (Please be specific with dates)

Please list your starting wage and ending wage.

Please list your starting position and your ending position.

Name of Supervisor

May we contact?

Yes

No

Please list what your job responsibilities were, and your reason for leaving.

In addition to your work history, are there other skills, qualifications, or experience that we should consider?

Please list three references, their phone numbers, and how long you have known them.

Please type your digital signature below, certifying that the facts set forth in this application are true and complete to the best of your knowledge.

By signing you are signifying that you understand that employment at this company is "at will", which means that either you or the company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute.