First Name
Last Name
Home Phone
Cell Phone
E-Mail

Address
City
State
Zip Code

Date of Birth

Enter your license number and State.

What type of employment are you interested in?

Full-Time Part-Time Temporary Summer Help

What position are you applying for?

When are you available to begin work?

Please list your education.

Please list any specialized training.

Please list your current or last employer information.

Company
Address
Phone
Supervisor
Start Date
End Date
Starting Salary
Ending Salary
Reason for Leaving
Job Duties

Please list other previous employer information.

Company
Address
Phone
Supervisor
Start Date
End Date
Starting Salary
Ending Salary
Reason for Leaving
Job Duties

Please list other previous employer information.

Company
Address
Phone
Supervisor
Start Date
End Date
Starting Salary
Ending Salary
Reason for Leaving
Job Duties

Please list what skills you possess related to this position.

Please list what value you would add to this company if hired.

Please list what you feel are the most important features of your work history.

Please answer yes or no to the following questions:

May we contact your current employer?
Are you currently on lay off status?
Are you able to perform the functions of the job for which you are applying?
Have you been convicted of a DUI in the last 7 years?
Do you have a reliable means of transportation?
Would you be able to travel or work overtime as needed?

List any other relevant information below.

Please read each statement closely and initial each acknowledging your understanding.

Disclosure to Applicants Concerning Drug/Alcohol Testing If you are offered a position with the Company, you will be given a drug/alcohol test as a condition of employment.  Your refusal to timely submit to a drug/alcohol test or your failure to pass such a test means you will not be employed by this company.  Neither the collector of specimens nor the medical professional who reviews the test results will be a company employee.  The test results will be kept confidential.  The individual undergoing testing will not be directly observed while providing the specimen unless there are reasonable grounds to believe the individual may alter or substitute the specimen.  Negative test results are required as a condition of employment.
Complete and Accurate Information I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge.  I further certify that I have personally completed this application.  I understand that any omission or misstatement of material fact on this application, or any other document used to secure employment, shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
At-Will Employment I understand and agree that if I am employed, my employment will be “at-will”, which means that the Company may terminate the employment relationship at any time, with or without cause and with or without notice.  Likewise, the Company will respect my right to terminate my employment at any time, with or without cause and with or without notice.  I further understand that any prior representation, whether expressed or implied to the contrary is hereby superseded and that no promise or representation contrary to the foregoing is binding on the Company unless made in writing and signed by the Company’s president.
Testing Authorization If offered a position with the Company, I hereby agree to any legally permitted physical, psychological, skill, drug or medical test required by the Company as a condition of employment.
Investigation Authorization I authorize investigation into all statements and references contained in this application.  Said investigation may include credit, driving, criminal background, references and other background checks.  By applying for this job, I also authorize post-hire investigation into my credit, driving and criminal background.
Company Obligation I understand and agree that the Company’s acceptance of this job application does not mean that a position for which I am qualified is open (unless specifically posted) or that the company has agreed to hire me.  I understand that the Company is under no obligation to hire me as the result of accepting this completed application.

I authorize investigation of all statements contained in this application for employment. I understand that misrepresentation or omission of facts called for hereon will be sufficient cause for cancellation of consideration for employment or dismissal from the company's service if I have been employed. I understand that if I am employed, a certified birth certificate or other evidence of birthplace and citizenship is required.

 

If you agree to the above information/authorization, submit this application.