Employment

 

Application for Employment

General Information

First Name:  Last Name: Middle Initial: 

Street Address:

City: State: Zip:

Home Phone:    Mobile Phone:   Email:

Position Applying For:    Wage / Salary Desired: $

Are you available to work full time, Monday through Friday between the hours 6am and 6 pm? 

Are you available on nights and weekends? 

What date can you begin work? 

Are you 18 years of age or older? 

Can you provide evidence of legal eligibility to work in the US? 

Any offer of employment is conditioned upon completing form I-9 and providing appropriate documents for identity and work authorization.

Have you ever been convicted of a misdemeanor or felony offense? 
If yes, describe the nature of the offence, when and were convicted and current status of the case:

Name of High School Attended:    Graduate:    GED? 

Name of College or Technical School attended:   Major: Graduate? 

Are you presently enrolled in school? 
If yes, when is your expected degree date? 

List any job-related skills or accomplishments, including military service:

Employment History

Upload your resume here, then complete the rest of this section.

May we contact your current employers before you are offered a position? 

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Name of Employer: 

Position:   Start Date:   End Date: 

Supervisor: 

Starting Wage:   Ending Wage: 

Reason for Leaving:

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Name of Employer: 

Position:   Start Date:   End Date: 

Supervisor: 

Starting Wage:   Ending Wage: 

Reason for Leaving:

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –

Name of Employer:

Position:  Start Date:  End Date: 

Supervisor: 

Starting Wage:   Ending Wage: 

Reason for Leaving:

Disclosures

Carefully read and understand each statement before acknowledging and submitting your application. By marking these disclosures and completing the electronic signature area of this application you agree to submit this application by electronic means.

 I certify that all the information provided in this employment application is true and complete to the best of my knowledge. I understand that any false or incomplete information may disqualify me from further consideration for employment and may result in my immediate discharge if discovered at a later date.

 I authorize investigation of all statements contained in this application, including a criminal background check.

 I authorize the investigation of work history and current and past educational statements. Current employers will only be contacted if previously authorized in this application.

 I authorize any person, school, employer and other organizations to provide information concerning my employment and other relevant information that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

 I understand any offer of employment will be contingent upon a pre-employment drug test and I may be subjected to random drug testing during my employment.

Electronic Signature

An electronic signature has the same legal effect and can be enforced in the same way as a written signature.

 By checking this box and typing my name below, I am electronically signing my application.

Type Name:      Date: 

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