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: (mm/dd/yy)    
Middle name:
     
     
     
City: State: Zip:
     
     
Social Security #
     
     
     
     
 
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.)
 
Are you looking for full-time employment?
 
 
Have you ever been convicted of a felony? (This will not necessarily affect your application.) 
 
If yes, please describe conditions.
 
Education
 
School Name and Location   
 
 
 
Year Major Degree:
 
College:
 
Year Major Degree:
 
Post-College:
 
Year Major Degree:
 
Other Training:
 
Year Major Degree:
 
 

Employment History (Start with most recent employer)

 
 
Address Telephone
 
Date Started: Starting Wage $ Starting Position
 
Date Ended Ending Wage $ Ending Position
 
Name of Supervisor:
 
May we contact?
 
Responsibilities:
 
Reason for Leaving:
 
 
Company Name:
 
Address Telephone
 
Date Started: Starting Wage $ Starting Position
 
Date Ended Ending Wage $ Ending Position
 
Name of Supervisor:
 
May we contact?
 
Responsibilities:
 
Reason for Leaving:
 
 
Company Name:
 
Address Telephone
 
Date Started: Starting Wage $ Starting Position
 
Date Ended Ending Wage $ Ending Position
 
Name of Supervisor:
 
May we contact?
 
 
 
 
 

By clicking "Submit" I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history.
I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing.