Back To Home Page

APPLICATION FOR EMPLOYMENT

If you need help to fill out this application form, or for any phase of the employment process, please notify the person who gave you this form and we will make an effort to accommodate your needs in a reasonable amount of time.

APPLICANT INSTRUCTIONS

  1. Please read "Applicant Note."

APPLICANT NOTE

This application form is intended for use in evaluating your qualifications for employment. It is not an employment contract.

Please answer all appropriate questions completely and honestly. False or misleading statements on this form, and during the interview, are grounds for terminating the applicant process or employment. All qualified applicants will receive consideration without discrimination because of race, sex, marital status, age, creed, national origin or the presense of disabilities. A felony conviction will not necessarily disqualify an applicant from employment. Additional testing of job-related skills may be required prior to employment. After an offer of employment and prior to reporting for work, you may be required to provide a medical history and/or submit to a medical exam and a drug screen.

Availability

For which posistion are you applying:
What date can you start: Which category would you prefer: Full Time Part-Time
When are you available to work: Weekdays Weekends Evenings Nights Overtime Other

Employment History
Please list your three most recent employers. Answer all questions. Since we will make every effort to contact previous employers, the correct telephone numbers are important. List the reason for any periods of unemployment under "Comments"

Most Recent Employer

Yes No "Are you working for this employer"
Yes No "If yes may we contact"
Company Name : City/State: Phone No:.
From: To: Job Title: Supv. Name:
Dutie:
Salary: Reasons for Leaving:

Second Most Recent Employer

Company Name: City/State: Phone No:
From: To: Job Title: Supv. Name
Duties:
Salary: Reasons for Leaving:

Third Most Recent Employer

Company Name: City/State: Phone No:
From: To: Job Title: Supv. Name:
Duties:
Salary: Reasons for Leaving:
Education
Please Select highest level grade completed: 7 8 9 10 11 12 13 14 15 16 16+
  Name: City/State: Gradute?
High School:
College:
Other:
References
Inclue only individuals familiar with your work ability. Do not include relatives.
Name: Address: Phone: Years Known/Relationship:
Security
Yes No Have you every used any other name than the one on this form? If yes, please list previous name under "comments"
Yes No Have you ever been convicted of a felony? If yes, describe on in comments. (A felony conviction will not necessarily disqualify you from employment.)
Job-Related Questions
Note: Do not answer any question that believe to be non-job related.
Yes No Are you over 16 years of age?
Yes No Are you over 18 years of age?
Yes No If the job requires, do you have a valid driver's license?
Please list any other skills, certificates, etc. That may be job-related, or that you feel would be of value to this job or company
Comments
Certification And Release
I certify that I have read and understand the Applicant Note on page one of this form, and the answers and statements given by me are complete and true to the best of my knowledge. I understand that any false information, deletions, or misrepresentations of facts called for this application may result in rejection of my application or discharge at any time during my employment. I authorize the company, and/or its agents, including consumer reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records.
I aurthorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information.
I also understand, the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment
Singature: Date: