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Employment/Job Application #1

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[COMPANY NAME] APPLICATION FOR EMPLOYMENT

[Company Name] is an equal opportunity employer. [Company Name] does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service or any other characteristic protected by law.

PERSONAL INFORMATION

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

Name ______________________________________ Date_______________________

Address _________________________________________________________________

E-mail Address ____________________________________________________________

Home Phone # ___________________ Mobile Phone # ___________________________

Are you eligible to work in the U.S? ___Yes ___No

Are you at least 18 years or older? (If no, you may be required to provide authorization to work.) ___Yes ___No

Have you ever been terminated from employment or asked to resign by an employer? ___Yes ___No

If yes, please provide company names and details __________________________________

Can you work any shift? ___Yes ___No If no, explain: ______________________________

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

EMPLOYMENT DESIRED

Date you can start _________________Hourly rate/Salary desired _____________________

Position desired ______________________________________________________________

Are you currently employed? ____ If so may we inquire of your present employer? _________

REFERRAL SOURCE

How did you hear about us? Walk In Advertisement Referral Other

Have you ever worked for this company before? ___Yes ___No Explain___________________________

Do you know anyone who works for our company? Yes No If yes, who? __________________

EDUCATION	Name and location of school	No. of yrs. Attended	Degree Received	Subjects studied/Major
High School
College or University
Trade, Business or Correspondence School

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.

From	To	Employer Name	Telephone ( )
Job Title		Address
Immediate supervisor and title		Summarize the nature of work performed and job responsibilities
Reason for leaving

From	To	Employer	Telephone ( )
Job Title		Address
Immediate supervisor and title		Summarize the nature of work performed and job responsibilities
Reason for leaving

From	To	Employer	Telephone ( )
Job Title		Address
Immediate supervisor and title		Summarize the nature of work performed and job responsibilities
Reason for leaving

From	To	Employer Name	Telephone ( )
Job Title		Address
Immediate supervisor and title		Summarize the nature of work performed and job responsibilities
Reason for leaving

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain. _________________________________________________________________________

REFERENCES
Give the names of three persons not related to you, whom you have known at least three (3) years.

Name	Address, Phone, Email	Company	Years Acquainted
1
2
3

Please read carefully before signing.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for [Company Name] to hire me. If I am hired, I understand that either [Company Name] or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of [Company Name] has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to [Company Name] true and complete information on this application. No requested information has been concealed. I authorize [Company Name] to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

Date _____________ Signature _______________________________________________

THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE ABOVE.