EMPLOYEE APPLICATION

Date

Position(S) Applied For

How did you learn about us?

Last Name

First Name

Middle Name

Social Security Number

Have you ever used another name for work, business or school?

Street Address

City

State

Zip Code

Home Phone Number

Cell Phone Number

Are you at least 18 years of age?

Have you ever filed an application with us before?

Have you ever been employed with us before?

On what date would you be available to work?

Are you available to work:

Are there any hours or days that you cannot work?

Can you travel if the job requires it?

Can you relocate if the job requires it?

Do you currently use illegal drugs?

Will you agree to be tested for the current illegal use of drugs?

Have you ever been convicted, plead guilty or received court-ordered community service, deferred adjudication, probation or pre-trial diversion for any crime (misdemeanors and felonies)? You may be asked to verify any criminal record. (Conviction of a crime does not automatically prohibit consideration for employment)

Have you served in the United States Military?

If you answered yes to the question above, please list dates of service, highest ranks held, and rank at discharge below

Education: Name and Address of Elementary School

Number of Years Completed

Did you graduate?

Education: Name and Address of High School

Number of Years Completed

Did you graduate?

Education: Name and Address of College, Trade, or Vocational School

Number of Years Completed

Did you graduate?

Please list any degree(s) received or subject(s) studied

Please list any honors/awards received

Indicate all languages you can speak, read and/or write

Describe any specialized training, apprenticeship, skills and extracurricular activities which would assist in considering you for employment

Please list any professional or vocational licenses (real estate, plumbing, electrician, air conditioning, pest control applicator, etc.) or certifications (such as, CAM, CAMT, CAPS, NALP, or CPM) that relate to the job for which you are applying?

Do you have a valid Driver's License?

Driver's License Number

Please provide all employment information for the past 10 years, or 5 employers, whichever is greater.

Are you currently employed?

May we contact your current employer at this time?

If you answered no above, please explain below.

Employer (1)

Address, City, State

Telephone Number

Dates Employed

Job Title

Work Performed

Hourly Rate/Salary

Reason for Leaving

Employer (2)

Address, City, State

Telephone Number

Dates Employed

Job Title

Work Performed

Hourly Rate/Salary

Reason for Leaving

Employer (3)

Address, City, State

Telephone Number

Dates Employed

Job Title

Work Performed

Hourly Rate/Salary

Reason for Leaving

Employer (4)

Address, City, State

Telephone Number

Dates Employed

Job Title

Work Performed

Hourly Rate/Salary

Reason for Leaving

Employer (5)

Address, City, State

Telephone Number

Dates Employed

Job Title

Work Performed

Hourly Rate/Salary

Reason for Leaving

List 3 References and Contact Information (Not relatives or acquaintances of less than 2 years

Name of present Landlord

Phone number of present Landlord

Name of previous Landlord

Phone number of previous Landlord

Summarize special job-related skills and qualifications acquired from employment or other experience.

Special Skills (check all that apply)
ComputerCopy MachineFaxSpreadsheet SoftwareProduction/Mobile MachineryCalculatorTypewriterWord Processing Software

State any additional information you feel may be helpful to us in considering your application

Emergency Contact

Emergency Contact Phone Number

I give the employer and authorized representatives the right to make a thorough investigation of any of the information I have provided and to perform reference/background checks. These investigations may involve contact with my family, current and former business associates and neighbors, as well as public authorities and others with whom I am acquainted. Any conditional offer of employment may require that I undergo and pass a physical examination and/or substance abuse evaluation provided at the employer’s expense, by a physician or approved by the employer. I understand that if I refuse to be tested, or if the drug test results are positive for the use of illegal drugs, I will not be considered for employment. I understand that the employer may request that I take job-related written and skill tests (if applicable) for the job for which I am applying. I understand that if I refuse to be tested I will not be considered for employment. I authorize all current and former employers, educational institutions and military authorities, whether or not listed on the application, to furnish the employer with complete information concerning my employment, academic transcripts, and service records. The information requested may include inquiries regarding my work habits, other related activities, abilities, character and the cause of my separation. I release each of the above references and the employer and authorized representatives from any liability for damages that may result from the furnishing of or the use of any of this information. I understand that, should the employer employ me, my employment is “at will”. Employment at will means that I may resign my employment at any time, with or without reason or cause and that I may be terminated at any time by the employer, with or without reason or cause, with or without prior notice. The employer will not be liable for any wages, salary, or other benefits other than those earned prior to the termination of my employment. No written or oral offer of employment, or other benefits related to employment will be viewed as establishing an employment contract. If employed, I will abide by the employer’s current and continually modified policies, procedures and/or rules. I understand that the employer requires reliable attendance and job performance; I understand that the employer may require that I work various shifts and/or schedules. I understand that any employment is subject to a change in conditions, wages, benefits and company policies. I understand that if the employer extends a conditional offer of employment, I may be asked to sign the following authorizations and/or documents: Authorization for Medical Exam, Authorization to Test for the Current Use of Illegal Drugs, Authorization to Obtain Consumer Reports (as required by the federal Fair Credit Act), Driver’s License or other identification, Federal I-9 Form, including verification of right to work. I certify that all statements contained in this application (including attachments, if any) are true, correct and complete. If the employer, during its investigation of my application, or later if I am employed, discovers that statements have been omitted or are false, incomplete or misleading, I understand that I may receive no further consideration for employment and that this will result in grounds for dismissal.

Applicant's Signature

Applicant's Email Address

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