Employment Form

All applicants will be considered for employment without regard to race, religion, color, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other status protected by law. We are an Equal Opportunity Employer.

Name:

Date:

Address:

Soc.Sec:

Phone:

Home Phone:

e mail:

Business Phone:

Position(s) applied for:

Who referred you to our company? Advertisement Private Employment Agency Friend
Are you legal age to work ? (If no, a work permit will be required.) yes no

To the best of your knowledge, are you legally eligible to work in the United States? yes no
(Should you be hired, you will be required by law to provide documents verifying your employment eligibility).

Date you are available to start work:

Salary or wages desired: $ Hr. Wk.

What type of employment are you applying for? (check all that apply)
Full Time Part Time Night Shift Temporary

If you are applying for Part Time, Night, Shift or Temporary employment, please specify days and hours you are available:
Mon.
Tue.
Wed.
Thu.
Fri.
Sat.
Sun.

NOTE: Every consideration will be given to work availability information provided by applicant; however there is no guarantee the Company can offer employment that accommodates availability to work.

Have you ever applied for work here before? yes no
If Yes, enter date here:
Were you ever employed by us before? yes no
If Yes, enter date here:

If you are applying for Full Time employment, can you work overtime if necessary? yes no
Are you employed at the present time? yes no
If YES, can we contact your present employer? yes no

Do you have any relatives now employed by this Company? yes no
If YES, list name(s) of employee(s):

Have you ever been bonded in prior employment? yes no
If YES, list name(s) of employer(s):

Have you ever been convicted of a crime (excluding misdemeanors and traffic offenses)? yes no
If YES, list convictions: (a conviction does not necessarily disqualify an applicant for the position being applied for).

EDUCATION
GRAMMAR SCHOOL
Name:

Location:

Number of years completed:

Did you graduate? yes no

HIGH SCHOOL
Name:

Location:

Number of years completed:

What was your course of study? Academic Business Trade or Technical Other
Did you graduate? yes no

COLLEGE
Name:

Location:

Number of years completed:

What was your Major?

Degree:

Did you graduate? yes no

Did you enroll in a post-graduate course of education? yes no
If YES, what was your post-graduate field of study?

Degree:

TRADE, BUSINESS OR CORRESPONDENCE SCHOOL
Name:

Location:

Number of years completed:

Did you graduate? yes no
What was your course of training or study?

SPECIAL QUALIFICATIONS OR SKILLS
Use this space to describe any special qualifications or skills you have acquired through special training, prior employment or general experience:

Indicate foreign languages(s) you are familiar with:
Language:
Fluent Good Fair Speak Read Write
Language:
Fluent Good Fair Speak Read Write

MEMBERSHIPS
List Business, Trade, Professional, Community or Activities Memberships and any offices you may have held. (Exclude any organizations name and character of which would reveal race, religion, national origin or any other protected status):

PRIOR EMPLOYMENT
Employer:

From:

Address:

Position:

City, State, Zip:

Phone:

Supervisor's Name:

Reason for leaving:

Starting Salary/Wages:

Final Salary/Wages:

PRIOR EMPLOYMENT
Employer:

From:

Address:

Position:

City, State, Zip:

Phone:

Supervisor's Name:

Reason for leaving:

Starting Salary/Wages:

Final Salary/Wages:

PRIOR EMPLOYMENT
Employer:

From:

Address:

Position:

City, State, Zip:

Phone:

Supervisor's Name:

Reason for leaving:

Starting Salary/Wages:

Final Salary/Wages:

MILITARY SERVICE
Were you a member of the U.S. Armed Forces?
yes no
Branch:

Describe briefly your military duties:

Years served:

Rank at discharge:

PERSONAL REFERENCES
List three personal references. (exclude relatives or former employers).

APPLICANT'S STATEMENT
The information provided by me in this application for employment is true and complete to the best of my knowledge. Should I be employed by the Company, any misrepresentation or any false statement contained herein may be considered cause for possible dismissal.

The Company, in compliance with the provisions of the Fair Credit Reporting Act of Sept. 1997, may contact directly or employ the service of investigative agencies to obtain all necessary information from the references I have listed, or any other sources, concerning my prior employment, personal history or credit standing. I reserve the right to know the names and addresses of any investigative agencies used in order that I may learn the information contained in any reports furnished to the Company.

I understand this application does not constitute an employment contract of any kind. Should I be employed by the Company, I may resign such employment at any time at my discretion with or without prior notice and the Company may terminate my employment at any time at their discretion, with or without cause and with or without prior notice.

This application will be considered valid for a period of 60 days. After 60 days it will be necessary for me to submit a new application.

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