Employment Application

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 years.

Personal Information

First Name:	Middle Name:	Last Name:
Home Phone:	Work Phone:	Cell Phone:
Email Address:

Addresses

	Street:	City:	State:	Zip Code:	Since (Mo/Yr):	To (Mo/Yr):
Current Address:
Prior Address:
Prior Address:

Education

	School Attended:	City:	State:	Diploma:	Degree/Cert.:	Area of Study
High School:				No Yes	GED
Undergrad School:				No Yes
Grad School:				No Yes
Other School:				No Yes

Employment Information

Position Applied For:

Date You Can Start:

Desired Salary: $

Do You Prefer:

Can you work:

Weekends
Evenings

Available:

M Tu W Th F Sa Su

Not Available:

	Please answer all of the following questions.
1.	Are you at least 21 years of age and legally eligible to work for our company in the United States?	No Yes
2.	Have you worked for this business before?	No Yes
	If yes, please provide dates and locations.
3.	Have you received a description of the job or been made aware of the essential functions of the job for which you are applying?	No Yes
4.	Do you understand the job requirements?	No Yes
	If no, please explain.
5.	Are you on layoff and subject to recall?	No Yes
6.	Have you ever been discharged or asked to resign from a job?	No Yes
	If yes, please explain...
7.	Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?	No Yes
	If yes, please explain...

Employment History

May we contact your present employer?	No Yes
Please list your current and/or past employer information:

	Most Recent Employer	Prior Employer (1)	Prior Employer (2)	Prior Employer (3)
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:

References

	Reference (1)	Reference (2)	Reference (3)	Reference (4)
Name:
Address:
Telephone:
Relationship:
Years Acquainted:

Resume (Text Version)

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Upload File

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Security Code


	Type Name in Signature Box*:	Today's Date: 2010-03-11 14:59:34 CST