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Employment Application

PLEASE READ CAREFULLY
Note: Fields marked with a * require an answer. Please use "N/A" for "not applicable" if necessary. Applicants may be required to complete and sign a paper application for employment upon interview.

Incomplete information could disqualify you from further consideration. Please complete all fields.

Attach Resume:
Applying for:

Applicant Information

*First Name:
*Last Name:
MI:
*Address:
Apartment/Unit #
*City
*State
*Zip
*Phone:
*Email:
U.S. Citizen:
   Yes    No
If not, are you authorized to work in the U.S.?:
 Yes     No
*Have you ever worked for this company?:
 Yes   
 No
If yes, when?:
------ To ------
*Have you ever been convicted of a felony?
 Yes   
 No
If yes, explain briefly:
*Have you ever been terminated from employment or asked to resign?
 Yes   
 No
If yes, , please provide company names and details


Employment Desired

Date Available:
Salary Expected:
Can you work any shift?:
 Yes   
 No
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
Are you currently employed?:
 Yes   
 No
If so may we inquire of your present employer?:
 Yes   
 No


Referral Source

How did you hear about us?:
 Walk-In    Advertisement/Online Posting    Referal    Other
Do you know anyone who works for our company?:
 Yes     No
If yes, who?:


Education

High School:
Address:
Graduate:
Yes No
Degree:
College:
Address:
Graduate:
Yes No
Degree:
Other:
Address:
Graduate:
Yes No
Degree:

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.
Company Name:
Complete Address
(w/ City, State, Zip):
Phone:
Supervisor:
Job Title:
Responsibilities:
Starting Salary:
Ending Salary:
Start Date:
(mm/dd/yyyy)
 
End Date:
(mm/dd/yyyy)
 
Reason for Leaving:
May we contact your previous employer for a reference?
 Yes    No



References

Give the names of three persons not related to you, whom you have known at least (3) years.
Name:
Occupation:
Company:
Day Phone Numbers:
Address:
Name:
Occupation:
Company:
Day Phone Numbers:
Address:
Name:
Occupation:
Company:
Day Phone Numbers:
Address:

Military Service

Start Date:
(mm/dd/yyyy)
End Date:
(mm/dd/yyyy)
Branch:
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:

Applicant's Statement

Notification and Agreement

I hereby affirm that all information in this application is true and accurate to the best of my knowledge. I understand that the company can obtain criminal history record information on applicants for employment. Pursuant to the requirements of the Fair Credit Reporting Act, notice is given that a consumer report+ may be made in connection with your application for employment. I understand that any misrepresentation or falsification of this record or failure to disclose conviction for a felony or for any offense involving moral turpitude will be considered cause for dismissal.

If you are denied employment, either wholly or partly, because of information contained in a consumer report, a disclosure will be made to you of the name and address of the consumer-reporting agency making such report.

Signature below verifies you have read the above notice and understand what it means.




Submit

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