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Application for Employment

Contact Address

Street
City
State/Province
Zip/Postal Code

Requested Information

Your Name:
Phone Number we can contact you at:
Your Email Address:
Are you 18 years or older?
Are you legally authorized to work in this country?
Were you referred by an existing employee?
If you were referred, who referred you?

Employment Desired

Position
Date You Can Start
Salary Desired
Are you willing to work any day of the week, over time, and weekends?

Work History

Supervisor's Phone Number
Reason for Leaving
Company Name
Company Phone
Position Title
Address
City
State
Description, Duties, and Responsibilities
Start Date
End Date (Note if this position is still pending.)
Starting Pay
Ending Pay
Supervisor's Name
May we contact for a reference?
Supervisor's Phone Number
Reason for Leaving
Description, Duties, and Responsibilities
Start Date
End Date
Starting Pay
Ending Pay
Supervisor's Name
May we contact for a reference?
Company Name
Company Phone
Position Title
Address
City
State
Description, Duties, and Responsibilities
Start Date
End Date
Starting Pay
Ending Pay
Supervisor's Name
May we contact for a reference?

Experience

Can you perform the essential functions for the job in which you are applying for?
List any skills or aptitude you have that we may consider for the position in which you are applying for:
What qualifications, abilities, and strong points will help you succeed in this job?

Education

School or Institution
Location
Major/Discipline
Degree
Did you graduate?
End Date (Note if present.)

References: The names of three persons not related to you, whom you have known at least one year.

Name
Address
Phone Number
Years Known
Name
Address
Phone Number
Years Known
Name
Address
Phone Number
Years Known
May we contact your references?

Please read the following statements carefully and indicate your understanding and acceptance by signing & dating in the space provided.

"I certify that all the information submitted by me on this application is true and complete, and i understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if i am employed my employment may be terminated at any time in consideration of my employment, i agree to conform to the company's rules and regulations, and i agree that my employment and compensation can be terminated, with or without cause and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it's president, and then only when in wrong and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing. I understand that as a condition of employement, i will be required to provide legal proof of authorization to work in the u.s. i understand that some state agencies will check with the department of public safety, the federeal bureau of investigation, or any other organizations, for any criminal history in accordance with applicable status. I authorize any of the persons or organizations refered in this application to give you any and all information concerning my previous employement, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application.”

Agreement Confirmation

Please confirm you read and understand the above.