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EMPLOYMENT APPLICATION

  • If necessary, best time to call you at home is
  • May we contact you at work? . . . . . . . . . . .
  • If yes, work number and best time to call:
  • If you are under 18 and it is required, can you furnish a work permit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
  • If no, please explain:
  • Have you submitted an application here before?
  • If yes, give date(s) and position(s):
  • Have you ever been employed here before?
  • f yes, give dates From
  • Are you legally eligible for employment in this country?
  • Date available for work . . . . . . . . . . . .
  • What is your desired salary range or hourly rate of pay?
  • Type of employment desired
  • Will you relocate if job requires it? . . . . . .
  • Will you travel if job requires it? . . . . . .
  • If they have been explained to you, are you able to meet the attendance requirements of the position?
  • Will you work overtime if required?
  • If no, please explain
  • Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)? This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.
  • Have you ever been bonded? . . . . . . . . . . .
  • Answering "yes" to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
  • If yes, please provide date(s) and details
  • Have you entered into an agreement with any former employer or other party (such as a non-competition agreement) that might, in any way, restrict your ability to work for our company?
  • If yes, please explain:
  • 1.Employment History

  • Starting with your most recent employer, provide the following information
  • Employer
  • Telephone #
  • Starting job title/final job title
  • Immediate supervisor and title (for most recent position held)
  • May we contact for reference?
  • Why did you leave?
  • Summarize the type of work performed and job responsibilities
  • What did you like most about your position?
  • What were the things you liked least about the position?
  • Dates employed: to
  • Compensation (Starting)
  • Commission/Bonus/Other Compensation $
  • Compensation (Final)
  • Commission/Bonus/Other Compensation $
  • 2.Employment History

  • Starting with your most recent employer, provide the following information
  • Employer
  • Telephone #
  • Starting job title/final job title
  • Immediate supervisor and title (for most recent position held)
  • May we contact for reference?
  • Why did you leave?
  • Summarize the type of work performed and job responsibilities
  • What did you like most about your position?
  • What were the things you liked least about the position?
  • Dates employed: to
  • Compensation (Starting)
  • Commission/Bonus/Other Compensation $
  • Compensation (Final)
  • Commission/Bonus/Other Compensation $
  • 3.Employment History

  • Starting with your most recent employer, provide the following information
  • Employer
  • Telephone #
  • Starting job title/final job title
  • Immediate supervisor and title (for most recent position held)
  • May we contact for reference?
  • Why did you leave?
  • Summarize the type of work performed and job responsibilities
  • What did you like most about your position?
  • What were the things you liked least about the position?
  • Dates employed: to
  • Compensation (Starting)
  • Commission/Bonus/Other Compensation $
  • Compensation (Final)
  • Commission/Bonus/Other Compensation $
  • 4.Employment History

  • Starting with your most recent employer, provide the following information
  • Employer
  • Telephone #
  • Starting job title/final job title
  • Immediate supervisor and title (for most recent position held)
  • May we contact for reference?
  • Why did you leave?
  • Summarize the type of work performed and job responsibilities
  • What did you like most about your position?
  • What were the things you liked least about the position?
  • Dates employed: to
  • Compensation (Starting)
  • Commission/Bonus/Other Compensation $
  • Compensation (Final)
  • Commission/Bonus/Other Compensation $
  • Employment History (continued)

  • If not addressed on previous page, have you ever been fired or asked to resign from a job?
  • Skills and Qualifications
  • Educational Background
  • Starting with your most recent school attended, provide the following information.
  • References
  • List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you
  • Related Information
  • To what job-related organizations (professional, trade, etc.) do you belong? Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.
  • Applicant Statement
  • I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

    I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, résumé or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

    I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

    I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

    If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

    I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

    This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status. Examples of prohibited harassment include, but are not limited to, unwelcome physical contact, offensive gestures, unwelcome comments, jokes, epithets, threats, insults, name-calling, negative stereotyping, possession or display of derogatory pictures or other graphic materials, and any other words or conduct that demean, stigmatize, intimidate, or single out a person because of his/her membership in a protected category. Harassment of our employees is strictly prohibited, whether it is committed by a manager, coworker, subordinate, or non-employee (such as a vendor or customer). The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.


    I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.
  • DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT. I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.