[Company Name] is an equal opportunity employer. [Company Name] does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service or any other characteristic protected by law.
PERSONAL INFORMATION
Incomplete information could disqualify you from further consideration. Please complete all fields.
Name ______________________________________ Date_______________________
E-mail Address ____________________________________________________________
Home Phone # ___________________ Mobile Phone # ___________________________
Are you eligible to work in the U.S? ___Yes ___No
Are you at least 18 years or older? (If no, you may be required to provide authorization to work.) ___Yes ___No
Have you ever been terminated from employment or asked to resign by an employer? ___Yes ___No
If yes, please provide company names and details __________________________________
Can you work any shift? ___Yes ___No If no, explain: ______________________________
Can you work overtime, including weekends? ___Yes ___No
Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation? ___Yes ___No
EMPLOYMENT DESIRED
Date you can start _________________Hourly rate/Salary desired _____________________
Position desired ______________________________________________________________
Are you currently employed? ____ If so may we inquire of your present employer? _________
REFERRAL SOURCE
How did you hear about us? Walk In Advertisement Referral Other
Have you ever worked for this company before? ___Yes ___No Explain___________________________
Do you know anyone who works for our company? Yes No If yes, who? __________________
| EDUCATION | Name and location of school | No. of yrs. Attended | Degree Received | Subjects studied/Major |
| High School | ||||
| College or University | ||||
| Trade, Business or Correspondence School |
EMPLOYMENT HISTORY Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.
Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain. _________________________________________________________________________
REFERENCES
Give the names of three persons not related to you, whom you have known at least three (3) years.
| Name | Address, Phone, Email | Company | Years Acquainted |
| 1 | |||
| 2 | |||
| 3 |
Please read carefully before signing.
I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for [Company Name] to hire me. If I am hired, I understand that either [Company Name] or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of [Company Name] has the authority to make any assurance to the contrary.
I attest with my signature below that I have given to [Company Name] true and complete information on this application. No requested information has been concealed. I authorize [Company Name] to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.
Date _____________ Signature _______________________________________________
THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE ABOVE.