APPLICATION FOR EMPLOYMENT
IT IS OUR
POLICY TO COMPLY WITH ALL APPLICABLE LOCAL, STATE AND FEDERAL LAWS PROHIBITING
DISCRIMINATION IN EMPLOYMENT BASED ON RACE, RELIGION, COLOR, SEX, AGE,
NATIONAL ORIGIN, DISABILITY, MILITARY STATUS OR OTHER PROTECTED CLASSIFICATION.
access to programs, services and employment is available to all persons.
If you need help filling out this application form or for any phase
of the employment process, please notify the person that provided you
this form and every effort will be made to reasonably accommodate your
Social Security No.
Home Tel. No
Business Tel. No.
May we call
you at your business number?
- TYPE OF WORK
position for which you are applying:
Do you wish to work:
If part-time, please specify hours or days:
Are there any
hours, shifts, or days you cannot or will not work?
If yes, when?
Are you able
to meet the attendance requirements of the position?
Are you willing
to work overtime as required?
What is your
minimum hourly or weekly salary requirement?
Do you have
any commitments to another employer that might affect your employment
training, skills, licenses and / or certificates that may qualify you
as being able to perform job-related functions in the position for which
you are applying:
III. EMPLOYMENT HISTORY
(Note: Your application will not be considered unless every question
in this section is answered. Since we make every effort to contact
previous employers, the correct telephone number of past employers is
critical. Ask for a phone book or call information if you need.)
employer or most recent employer first (use other side of this application,
if necessary). If you are currently employed, may we contact that
- EDUCATIONAL DATA
- GENERAL INFORMATION
Are you legally
authorized to work in the United States?
Are you below
the age of 18?
Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by
an employer covered by DOT agency drug and alcohol testing rules during the past two years?
In the past two years, have you been employed with an employer covered by DOT agency drug
and alcohol testing rules?
Have you ever
plead "guilty" or "no contest" to, or been convicted of a criminal
(Note: An affirmative answer will not automatically disqualify you from being
considered as a candidate for employment. Factors such as date
of the offense, seriousness and nature of the violation, rehabilitation
and position applied for will be taken into account.)
Have you previously
applied for employment here?
If yes, when?
Have you previously been employed by this company?
If yes, when?
Drivers license number if driving is an essential job function.
(Note: Include only individuals familiar with your work ability. Do
not include relatives.)
any other information you think would be helpful to us in considering
you for employment, such as additional work experience, special interest,
activities, accomplishments, etc.
the following carefully before signing this application form:
I certify that
all information I have provided in order to apply for and secure employment
with the employer is true, complete and correct.
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.
authorize, without reservation, the employer, its representatives, employees
or agents to contact and obtain information from any and all references
(personal and professional), former employers, public agencies, licensing
authorities and educational institutions and to otherwise verify the
accuracy of all information provided by me in this application, and
I release the employer and such other entities and individuals from
any liability for any damages whatsoever that may result from their
so doing. I also authorize all references (personal and professional),
former employers, public agencies, licensing authorities and educational
institutions to release any and all information concerning my background,
previous employment, education or any other information they might have,
personal or otherwise, with regard to any of the subjects covered by
this application, and I release all such parties from any liability
for any damages whatsoever that may result from their furnishing such
that this application remains current for only 90 days. 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 employed,
I understand that my employment will be at-will, and the employer reserves
the right to terminate my employment at any time, with or without cause
and without prior notice, except as may 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 the employer is authorized to make
any assurances to the contrary and that no implied, oral or written
agreements contrary to the foregoing express language are valid.
that after an offer of employment, and prior to reporting to work, I
may be required to submit to a medical review. Depending on company
policy and the needs of the assigned job, I may be required to complete
a medical history form and may be required to be examined by a medical
professional designated by the employer.
I also understand
that the illegal use of drugs is prohibited during employment.
As company policy provides, I may be required to submit to drug
testing to detect the illegal use of drugs prior to and during employment.