Employment Application

Name*

First Last

Today's Date*

Note: this application will remain active for only 90 days from today's date.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Please check the terms of employment below to qualify your application for review.*

Are you at least 18 years of age?*

Yes
No

Do you have a drivers license?*

Yes, I have a valid driver's license
No, I do not have a driver's license

Do you have a clean driving record? Please explain:*

I am interested in applying for the following position(s):*

Are you authorized to work in the USA?*

Yes
No

Can you verify your age by providing appropriate documentation?*

Yes
No

Emergency Contact

Name*

First Last

Relationship to you:*

Phone*

Preferences

Date available for work:*

Salary or hourly rate desired:*

What days and hours are you available for work?*

Are there any hours, shifts, or days that you cannot or will not work?*

Yes
No

If you have limited available hours please explain:

Education / Certificates / Training

Please list your level of education completed, where you went to school, what degree you hold, and any certificates or training that you have received:*

1. Previous Work Experience

Company Name

Supervisor's name:

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Start date and end date:

Job title, responsibilities, duties:

Wages:

State hourly and/or commission based salary.

Reason for Leaving:

May we contact your supervisor?

Yes
No

2. Previous Work Experience

Company Name

Supervisor's name:

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Start date and end date:

Job title, responsibilities, duties:

Wages:

State hourly and/or commission based salary.

Reason for Leaving:

May we contact your supervisor?

Yes
No

3. Previous Work Experience

Company Name

Supervisor's name:

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Start date and end date:

Job title, responsibilities, duties:

Wages:

State hourly and/or commission based salary.

Reason for Leaving:

May we contact your supervisor?

Yes
No

Reference One

Name*

First Last

Relationship to you:*

Phone

Email

Reference Two

Name

First Last

Relationship to you:*

Phone

Email

Reference Three

Name

First Last

Relationship to you:*

Phone

Email

Closing Terms

I authorize the company to conduct a reference and a background investigation, which may include driving record, criminal record, credit, and educational background and professional license. I understand and agree that employment may be contingent upon the results of the reference checks and the background investigation. I understand I will be required to provide information for compliance with the Immigration Reform and Control Act. I understand that I may be required to have a physical examination, drug test, and pre-employment evaluations. I hereby certify that the information contained in this application form is true and correct to the best of my knowledge and agree to have any of the statements checked by the company unless I have indicated to the contrary. I authorize the references listed above to provide the company any and all information concerning my previous employment and any pertinent information that they may have. Further, I release all parties and person from any and all liability for any damages that may result from furnishing such information by the company or any of its agents, employees, or representatives. I understand that any misrepresentation, falsification, or material omission of information of this application may result in my failure to receive an offer, or if I am hired, in my dismissal from employment. In consideration of my employment, I agree to conform to the rules and standards of the company and agree that my employment and compensation can be terminated at will, with or without cause, and with or without notice, at any time, either at my option or at the option of the company. Please check "yes" below to acknowledge that you understand and accept the above statements.

Yes, I understand and accept the statements above.
No, I do not agree nor accept the statements above.

Please read carefully before signing this last page of your Application for Employment

All information contained in this application is true to the best of my knowledge and belief. I understand that misrepresentation or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am selected/hired. I authorize this company to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with me or my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information, whether favorable or unfavorable, about me or my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to my employment or me. Regardless of whether or not I become elected/hired by this company, I recognize that this application is not and should not be considered a contract of employment for any definite period of time. If employed, I understand that I have been hired “At-Will” of the employer and my employment may be terminated at any time, with or without cause and with or without notice.

Original Signature of Applicant:

Date:

Our Company is an Equal Employment Opportunity employer. We adhere to a policy of making employment decisions without regards to race, color, religion, sex, age, disability or any other protected categories. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job related factors.

Comments

This field is for validation purposes and should be left unchanged.

Emergency Contact

Preferences

Education / Certificates / Training

1. Previous Work Experience

2. Previous Work Experience

3. Previous Work Experience

Reference One

Reference Two

Reference Three

Closing Terms

Please read carefully before signing this last page of your Application for Employment

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