Employment Application

Applications are considered for all positions without regard to race, religion, color, national origin, sex, marital or veteran status or in the presence of a non-related medical condition or handicap.

We are a drug-free employer and we may ask you to take a drug test as a condition of employment or at random times during your employment.

If accepted for employment you will be required to work evenings, holidays and weekends. You should not apply for employment with us if those requirements conflict with your other activities.

* Required Fields, enter 'n/a' or 'na' if not applicable or you do not know

Personal Information:

Date of Application:

*Last Name:

*First Name:

*Address:

*City:

*State:

*Zip:

*Phone (home or mobile):

Email:

*Are You a US Citizen?

YesNo

If not, do you have the legal right and documentation to work in the US?

YesNo

*Were you ever discharged by a company?

YesNo

If yes, give name of company:

Reason for discharge:

Position Applying For:

*Date Available to Start:

Open the calendar popup.

mm/dd/yyyy

Days and hours available for work:

Sunday

From

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

*May we contact at work?:

NoYes

*Work Type desired:

Full-TimePart-TimeTempSummer Only

Referred by:

Education - Schools / Colleges Attended:

High School:

Address:

# of Years Attended:

Year Graduated:

Graduated:

NoYes

College:

Address:

# of Years Attended:

Year Graduated:

Degree:

Graduated:

NoYes

Graduate School:

Address:

# of Years Attended:

Year Graduated:

Degree:

Graduated:

NoYes

Other:

Address:

# of Years Attended:

Year Graduated:

Degree:

Graduated:

NoYes

Employment Experience

Start with your present job or last job. Include military assignments and other volunteer activities. Exclude organizational names which indicate race, color, religion, sex, or national origin.

PLEASE GIVE INFORMATION PERTAINING TO THE PAST 5 YEARS OF EMPLOYMENT:

Employer 1:

Address:

City, State, Zip:

Phone:

Supervisor:

Job Title:

Date Started:

Open the calendar popup.

Date Ended:

Open the calendar popup.

List Major Duties:

Starting/Ending Salary:

Reason for Leaving:

Employer 2:

Address:

City, State, Zip:

Phone:

Supervisor:

Job Title:

Date Started:

Open the calendar popup.

Date Ended:

Open the calendar popup.

List Major Duties:

Starting/Ending Salary:

Reason for Leaving:

Employer 3:

Address:

City, State, Zip:

Phone:

Supervisor:

Job Title:

Date Started:

Open the calendar popup.

Date Ended:

Open the calendar popup.

List Major Duties:

Starting/Ending Salary:

Reason for Leaving:

Employer 4:

Address:

City, State, Zip:

Phone:

Supervisor:

Job Title:

Date Started:

Open the calendar popup.

Date Ended:

Open the calendar popup.

List Major Duties:

Starting/Ending Salary:

Reason for Leaving:

Date of Birth
(if under 18):

mm/dd/yyyy (Not Required)

U S Military Service:

Branch of Service:

Technical Specialization:

Rank Attained:

Special Skills:

Typing Speed (wpm):

Shorthand or Speedwriting (wpm):

CRT (Strokes per hour):

Software (List Programs):

Have you ever been convicted of a felony?

NoYes

References:

Name only those persons who are familiar with your work capabilities. Do not list relatives.

Name:

Phone:

Years known:

Address:

Position:

Name:

Phone:

Years known:

Address:

Position:

Name:

Phone:

Years known:

Address:

Position:

I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize investigations of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given on my application or interview may result in termination.