Employment Application

Yes
No
Yes
No
Yes
No
Full-Time
Part-Time
First Shift
Second-Shift
Yes
No
ANSWERING YES TO THIS 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.

Employment History

Provide the following information of your past four(4) employers, assignments or volunteer activities, starting with the most recent.
Yes
No
Later

Yes
No
Later

Yes
No
Later

TO
EMPLOYER
Yes
No
Later

Skills and Qualifications


 

Educational Background
(if job related)

HIGH SCHOOL NAME AND LOCATION
NUMBER OF YEARS COMPLETED
DID YOU GRADUATE?
COURSE OF STUDY
COLLEGE MAJOR
DEGREE
COURSE OF STUDY
OTHER
MAJOR
DEGREE
COURSE OF STUDY


References

NAME
TELEPHONE
NUMBER OF YEARS KNOWN


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 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) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered.

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, resume, or job interview. I hereby waive any and all rights and claims that I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in the employment and no question on this applicant 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 understand that this application remains current for 6 months. 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 to reapply and fill out a new application.

If I am hired, I understant that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as my 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 this employer is authorized to make any assurances to the contrary and that no implied, oral, written agreements contrary to the foregoing express launguage 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 authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.



DO NOT SUBMIT 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.

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