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Employee Application

Position applied for

How did you learn about us?

AdvertisementEmployeeEmployment AgencyFriendRelativeOther

First Name	Middle	Last Name
Address		Email
Home Phone	Cell Phone	Other Phone
Social Security Number

If you are under 18 can you provide required proof of your eligibility to work? YesNo

Have you ever filed an application with us before? YesNo

If yes, give date

Have you ever been employed by us before? YesNo

If yes, give dates (start-end)

Are you currently employed? YesNo

May we contact you at work? YesNo

Best Phone Number

May we contact your current employer? YesNo

Are you on lay-off and subject to re-call? YesNo

Are you legally eligible for employment in this country? YesNo

Type of employment desired Full-timePart-timeTemporary

Date available for work

Will you travel if your job requires it? YesNo

Are you able to meet the attendance requirements of this job? YesNo

Will you work overtime if required? YesNo

Have you been convicted of a felony within the last 7 years? YesNo

If yes, explain

Languages - List any foreign languages(s) you know and check the boxes that describe your skill level

Speak someSpeak fluentlyReadWrite

Speak someSpeak fluentlyReadWrite

Education

High School Name

Years Completed

Did you Graduate? YesNo

Graduation Date

Trade, College & Post Graduate Studies	Major	Years Attended
Did you Graduate? YesNo	Degree	Date of Graduation
Trade, College & Post Graduate Studies	Major	Years Attended
Did you Graduate? YesNo	Degree	Date of Graduation
Trade, College & Post Graduate Studies	Major	Years Attended
Did you Graduate? YesNo	Degree	Date of Graduation

List any special courses, specialized training, apprenticeships, skills, management development, training seminars, etc.

Professional References, not relatives
Name	Title	Company	Phone
Name	Title	Company	Phone
Name	Title	Company	Phone

Employment History
Employer (present or most recent)
Address
Phone		Supervisor
Reason for leaving
Starting Date	Ending Date	Starting Salary	Ending Salary
Titles and Duties
Employer
Address
Phone		Supervisor
Reason for leaving
Starting Date	Ending Date	Starting Salary	Ending Salary
Titles and Duties
Employer
Address
Phone		Supervisor
Reason for leaving
Starting Date	Ending Date	Starting Salary	Ending Salary
Titles and Duties

List Special Skills, Qualifications, Career Objectives

It is understood and agreed upon that any misrepresentation by me on this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed. I give the employer the right to investigate all references and to secure additional information about me if job-related. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. The employer is an Equal Opportunity Employer. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state or federal law. I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of this person's need for an accommodation that would be required by the American Disability Act. I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with our without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary. This application is current for only 60 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application.

Signature

Date

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