Employment Application
This company does
not discriminate on the basis of race, national origin, age,
sex, marital status or disability.
PLEASE READ THESE INSTRUCTIONS BEFORE YOU BEGIN
TO FILL OUT THE APPLICATION.
This
application shall be effective for 30 days after today's date.
If you have questions or need help with the application,
please let us know so that we can assist you. This is not a
contract. This employment application is being used for the
sole purpose of determining if you are qualified for the job.
It is very important that you answer all the questions
accurately. If you make false or misleading statements on this
application or during the interview, upon discovery, it will
be grounds for rejection of your application or termination of
your employment.
(*
designates required form fields) |
| Position |
| What position are you applying for? |
* |
| Location
applying for? |
* |
| Are you willing to relocate? |
|
|
| Personal Data |
| Name |
First
* Last
* |
| |
Middle
|
| Address |
* |
| Prior Address |
|
| SSN Number |
|
| Home Phone |
* |
| Work
Phone |
|
|
| Educational Data |
|
| High School |
Name
|
| |
Address
|
| |
Graduate
|
| |
Degree
|
| College |
Name
|
| |
Address
|
| |
Graduate
|
| |
Degree
|
| Other |
Name
|
| |
Address
|
| |
Degree
|
|
Employment Data
List all
employers in chronological order begining with the most
recent. |
| 1st Employer |
|
| Employer |
|
| Address |
|
| Phone |
|
| Position/Title |
|
| Work
Duties |
|
| Dates
Employed |
Start
End
|
| Reason
for leaving |
|
| Base
Pay |
per
|
| Supervisor Name |
|
|
| 2nd Employer |
|
| Employer |
|
| Address |
|
| Phone |
|
| Position/Title |
|
| Work
Duties |
|
| Dates
Employed |
Start
End
|
| Reason
for leaving |
|
| Base
Pay |
per
|
| Supervisor Name |
|
|
| 3rd Employer |
|
| Employer |
|
| Address |
|
| Phone |
|
| Position/Title |
|
| Work
Duties |
|
| Dates
Employed |
Start
End
|
| Reasone
for leaving |
|
| Base
Pay |
per
|
| Supervisor Name |
|
|
| Questions related to your job
abilities |
| Have You been given a job description or had the
requirements of the job explained to you?
|
Do you understand these requirments?
|
| Can you preform the requirments of this job with or
without resonable accommodation?
|
I am Willing to submit to a drug test prior or during
employment?
|
I understand that comany policy may provide that I
submit to a medical review after an offer of employment and I
agree to submit to said review.
|
Have you been convicted of or have served time for a
felony in the past 7 years?
|
If so
please describe. (This information will be evaluated with
reference to its relation to ability to preform this job.)
Please list the date of the offence.
|
Have you used other names or social security numbers
besides those listed on this application?
|
If so; please list:
|
|
| If you are applying for a position which
requires you to operate a motor vehicle, please answer the
followint questions. |
Do you have a valid drivers license from the state in
which you reside?
|
| License Number |
|
| Type |
|
| State |
|
Have you been convicted of any moving violations within
the past five years?
|
If so, list the date and type of violation.
|
Have you ever caused property damage while driving a
vehicle during past employment?
|
If so, describe.
|
|
References
Please list only
references who are aquainted with your work-related
activities. |
| 1st Reference |
|
| Name |
|
| Address |
|
| Phone |
|
| Years Known |
|
|
| 2nd Reference |
|
| Name |
|
| Address |
|
| Phone |
|
| Years
Known |
|
|
Please Read Carefully.
I verify
that all information in this employment application is tru and
correct. The company is authorized to contact prior employers,
schools, and references listed above and they may provide my
records, reason for leaving, and all other information they
may have concerning me and I release all parties from any and
all liabillity or claims for damage whatsoever that may result
therefrom. I releasethe company of liability for injuries
resulting from any physical or mental disorders. I have read
all of the information on this
application.
I understand that the
employment application is not a contract. I understand that
employment by the company is at will. I acknowledge that if
hired, either the company or i may terminate the employment at
any time, with or without notice, or cause, at any time. I
understand that if I have misled the company by providing
false information, misleading information, or omissions on
this application, it may result in rejection of my application
or discharge from employment. I understand that the use of
illegal drugs is prohibited.
|
1342 W 100 N.