Standard Application for Employment

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications.

Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application. You may attach a résumé, but all questions must be answered.

Standard Application for Employment

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications.

Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application. You may attach a résumé, but all questions must be answered.

Position applying for

PERSONAL DATA

Name (last, first, middle)

Street Address and/or Mailing
Address

City

State

Zip

Home Telephone Number

Business Telephone Number

Cellular Telephone Number

Date you can start work

Salary Desired

Do you have a High School Diploma or GED?
YesNo

POSITION INFORMATION

Hours:

Full TimePart Time

Check all that you are willing to work?

Days
Evenings
Swing
Graveyard
Weekends

Status:

RegularTemporary

Are you authorized to work in the U.S. on an unrestricted basis?

YesNo

Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.) If yes, explain

YesNo

Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job?

YesNo

Can you perform these essential functions of the job with or without reasonable accommodation?
.

YesNo

QUALIFICATIONS

Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training

	School Name	Degree	Address/City/State
School
School
Other
SPECIAL SKILLS List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.

REFERENCES

Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don’t have three professional references, then list personal, unrelated references

Name	Address/City/State	Phone	Relationship

WORK HISTORY

Start with your present or most recent employment and work back. Use separate sheet if necessary. (INCLUDE PAID AND UNPAID POSITIONS)

Duties:
Job Title #1	Start Date (mo/day/yr)	End Date (mo/day/yr)
Company Name	Supervisor’s Name	Phone Number
City	State	Zip
Reason for Leaving	Starting Salary	Ending Salary

May we contact your present employer?
.

YesNo

Duties:
Job Title #2	Start Date (mo/day/yr)	End Date (mo/day/yr)
Company Name	Supervisor’s Name	Phone Number
City	State	Zip
Reason for Leaving	Starting Salary	Ending Salary

Duties:
Job Title #3	Start Date (mo/day/yr)	End Date (mo/day/yr)
Company Name	Supervisor’s Name	Phone Number
City	State	Zip
Reason for Leaving	Starting Salary	Ending Salary

Duties:
Job Title #4	Start Date (mo/day/yr)	End Date (mo/day/yr)
Company Name	Supervisor’s Name	Phone Number
City	State	Zip
Reason for Leaving	Starting Salary	Ending Salary

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in
my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.

I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment
relationship with any employee at any time, with or without cause, with or without notice to the other party

Applicant Signature

Attach File

Date

Standard Application for Employment

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications.

Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application. You may attach a résumé, but all questions must be answered.

Position applying for

PERSONAL DATA

Name (last, first, middle)

Street Address and/or Mailing
Address

City

State

Zip

Home Telephone Number

Business Telephone Number

Cellular Telephone Number

Date you can start work

Salary Desired

Do you have a High School Diploma or GED?
YesNo

POSITION INFORMATION

Hours:

Full TimePart Time

Check all that you are willing to work?

Days
Evenings
Swing
Graveyard
Weekends

Status:

RegularTemporary

Are you authorized to work in the U.S. on an unrestricted basis?

YesNo

Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.) If yes, explain

YesNo

Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job?

YesNo

Can you perform these essential functions of the job with or without reasonable accommodation?
.

YesNo

QUALIFICATIONS

Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training

	School Name	Degree	Address/City/State
School
School
Other
SPECIAL SKILLS List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.

REFERENCES

Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don’t have three professional references, then list personal, unrelated references

Name	Address/City/State	Phone	Relationship

WORK HISTORY

Start with your present or most recent employment and work back. Use separate sheet if necessary. (INCLUDE PAID AND UNPAID POSITIONS)

Duties:
Job Title #1	Start Date (mo/day/yr)	End Date (mo/day/yr)
Company Name	Supervisor’s Name	Phone Number
City	State	Zip
Reason for Leaving	Starting Salary	Ending Salary

May we contact your present employer?
.

YesNo

Duties:
Job Title #2	Start Date (mo/day/yr)	End Date (mo/day/yr)
Company Name	Supervisor’s Name	Phone Number
City	State	Zip
Reason for Leaving	Starting Salary	Ending Salary

Duties:
Job Title #3	Start Date (mo/day/yr)	End Date (mo/day/yr)
Company Name	Supervisor’s Name	Phone Number
City	State	Zip
Reason for Leaving	Starting Salary	Ending Salary

Duties:
Job Title #4	Start Date (mo/day/yr)	End Date (mo/day/yr)
Company Name	Supervisor’s Name	Phone Number
City	State	Zip
Reason for Leaving	Starting Salary	Ending Salary

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in
my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.

I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment
relationship with any employee at any time, with or without cause, with or without notice to the other party

Applicant Signature

Attach File

Date

Position applying for

PERSONAL DATA

Name (last, first, middle)

Street Address and/or Mailing
Address

City

State

Zip

Home Telephone Number

Business Telephone Number

Cellular Telephone Number

Date you can start work

Salary Desired

Do you have a High School Diploma or GED?
YesNo

POSITION INFORMATION

Hours:

Full TimePart Time

Check all that you are willing to work?

Days
Evenings
Swing
Graveyard
Weekends

Status:

RegularTemporary

Are you authorized to work in the U.S. on an unrestricted basis?

YesNo

Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.) If yes, explain

YesNo

Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job?

YesNo

Can you perform these essential functions of the job with or without reasonable accommodation?
.

YesNo

QUALIFICATIONS

Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training

	School Name	Degree	Address/City/State
School
School
Other
SPECIAL SKILLS List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.

REFERENCES

Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don’t have three professional references, then list personal, unrelated references

Name	Address/City/State	Phone	Relationship

WORK HISTORY

Start with your present or most recent employment and work back. Use separate sheet if necessary. (INCLUDE PAID AND UNPAID POSITIONS)

Job Title #1

Duties:
Start Date (mo/day/yr)	End Date (mo/day/yr)
Company Name	Supervisor’s Name	Phone Number
City	State	Zip
Reason for Leaving	Starting Salary	Ending Salary

May we contact your present employer?
.

YesNo

Job Title #2

Duties:
Start Date (mo/day/yr)	End Date (mo/day/yr)
Company Name	Supervisor’s Name	Phone Number
City	State	Zip
Reason for Leaving	Starting Salary	Ending Salary

Job Title #3

Duties:
Start Date (mo/day/yr)	End Date (mo/day/yr)
Company Name	Supervisor’s Name	Phone Number
City	State	Zip
Reason for Leaving	Starting Salary	Ending Salary

Job Title #4

Duties:
Start Date (mo/day/yr)	End Date (mo/day/yr)
Company Name	Supervisor’s Name	Phone Number
City	State	Zip
Reason for Leaving	Starting Salary	Ending Salary

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in
my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.

I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment
relationship with any employee at any time, with or without cause, with or without notice to the other party

Applicant Signature

Attach File

Date

Standard Application for Employment

Standard Application for Employment

PERSONAL DATA

POSITION INFORMATION

QUALIFICATIONS

SPECIAL SKILLS

REFERENCES

WORK HISTORY

Job Title #1

Job Title #2

Job Title #3

Job Title #4

Standard Application for Employment

PERSONAL DATA

POSITION INFORMATION

QUALIFICATIONS

SPECIAL SKILLS

REFERENCES

WORK HISTORY

Job Title #1

Job Title #2

Job Title #3

Job Title #4

PERSONAL DATA

POSITION INFORMATION

QUALIFICATIONS

SPECIAL SKILLS

REFERENCES

WORK HISTORY

Job Title #1

Job Title #2

Job Title #3

Job Title #4