Apply for Employment

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, veteran status or any other legally protected status.

Position(s) applying for*

Date

Why are you seeking a new job at this time?*

Applicant Information

First Name*

Middle

Last Name*

Street Address*

City*

State*

Zip Code*

Phone*

If hired, do you have a reliable means of transportation to get to work?*

Yes

Transportation Method

Are you at least 18 years old?*

Yes

If you are under 18 years of age, can you furnish a work permit?

Yes

Driver's License Number

State

Expiration Date

Are you legally eligible for employment in the U.S.?*

(Proof of U.S. citizenship or immigration status is required if hired)

Yes

Employment Information

Are you seeking full time, part time or temporary employment?*

	Full Time
	Part Time
	Temporary

List times you are not available to work*

Are you willing to work overtime?*

Yes

Weekends

Holidays

Are you currently employed?

Yes

If hired, when would you be able to start?*

Have you ever worked for this organization before?*

Yes

If yes, name used

List any friends or relatives employed by this company

Have you ever been discharged or asked to resign from any position?*

Yes

If yes, please describe

If applicable, please refer to the attached job description for the position for which you are applying. Are you able to perform all of these tasks with or without reasonable accommodation?

Yes

Please describe which tasks, if any, you will need accommodation to perform, and explain what type of accommodation you will need

Education (Select the highest level achieved)

Name of Elementary School

Location of Elementary School

Name of Secondary School

Location of Secondary School

If in high school, are you enrolled in a recognized co-op program?

Yes

If yes, identify program and school

Name of College

Location of College

Degree & Major

Minor

Work History (Please begin with most recent)

Company #1 (most recent)

Phone Number

Address

City

State

Zip Code

From

Job Title

Supervisor's Name & Title

Briefly Describe Duties

Reason for Leaving

Company #2

Phone Number

Address

City

State

Zip Code

From

Job Title

Supervisor's Name & Title

Briefly Describe Duties

Reason for Leaving

Company #3

Phone Number

Address

City

State

Zip Code

From

Job Title

Supervisor's Name & Title

Briefly Describe Duties

Reason for Leaving

Company #4

Phone Number

Address

City

State

Zip Code

From

Job Title

Supervisor's Name & Title

Briefly Describe Duties

Reason for Leaving

Have you worked for any of these organizations or attended school under a different name?*

Yes

If YES, given name and organization(s)

May we contact the employers listed above?*

Yes

No, do NOT contact

If not, list the employers you do not wish us to contact and why

Authorizations & At-Will Employment Agreement

(Please read carefully, then sign and date below)

I certify that I have personally completed this application. I declare that the information provided in this employment application is true and complete and I understand that any false information or significant omissions may disqualify me from further consideration for employment and may be justification for my dismissal from employment if discovered at a later date. I agree to immediately notify this company if I should be convicted of a crime while my job application is pending or during my employment, if hired.

I authorize this company to make an investigation of all information contained in this employment application and i release from liability all companies and corporations supplying such information. I understand any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge.

I specifically authorize and direct my current and former employers to supply employment-related information to this company and do hereby release my current and former employers from liability for providing information to this company.

Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer.

AT-WILL EMPLOYMENT AGREEMENT

I understand and agree that nothing contained in this application, or conveyed during any interview is intended to create and employment contract between the company and me. In addition, I understand and agree that if you employ me, in consideration of my employment, my employment and compensation will be at-will, for no definite period of time, and may be terminated at any time, for any reason, or for no reason at all. I understand that only the company's President is authorized to change the employment-at-will status and such a change can only be done in writing.

I have read, understand, and agree to the above*

Signature*

Date*

Full Name*

	Newspaper
	Employee
	Walk-in
	Relative
	Other

	Morning
	Afternoon
	Evening
	Night
	No Preference

	9		10		11		12
	G.E.D