Employment Application

We are an Equal Opportunity Employer

Application Information

Name {first, middle, last} (*)

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Address (*)

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City,state,zip code (*)

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Day Telephone (*)

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Special Skills (*)

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How were you referred to this company? (*)

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Friend / Relation (Their Name) (*)

You have indicated you were referred by a friend or relative. Please enter the persons name here.
Other (Please Explain.) (*)

You have indicated that you were referred by a source of "Other". Please explain here.
Part -Time or Full-Time Desired

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Salary Preference

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Shift Preference

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When can you start? (*)

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Position Applying For? (*)

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Invitation to Identify for Affirmative Action Purposes

Our organization is commited to the employment and advancement of minorities, females, individuals with disabilities, and veterans. If you fall into one of these protected classifications, we invite you to identify yourself and recieve coverage under our company's Affirmative Action Plan. You may inform us of your desire to benefit under the program at this time and/or any time in the future.

Completion of this section is voluntary and in no way affects the decision regardig your employment opportunity. The information provided will be held in the strictest confidence, will be maintained in a separate file, and will not be in a manner inconsistent with the Acts.

Please Choose One:

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Indicate The Appropriate Race/Ethnic Group:






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Education

High School (*)

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Location (City, State) (*)

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No. Years Attended (*)

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Diploma? (*)

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College

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Location (City, State)

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No. Years Attended

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Major Subjects

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Diploma or Degree?

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Graduate

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Location (City, State)

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No. Years Attended

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Major Subjects

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Diploma or Degree?

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Other

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No. Years Attended

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Major Subjects

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Diploma or Degree?

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Employment History

Employer One

Name of Employer (*)

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Job Title (*)

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Description of Duties (*)

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Starting Salary (*)

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Ending Salary (*)

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Reason for Leaving (*)

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If currently employed, may we contact as a reference? (*)

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When did you start? { mm / yyyy } (*)

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When did you leave? ( mm / yyyy ) (*)

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Please Read Carefully Before Submitting This Form

1. All information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired.


2. I authorize the company to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with me or my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information, whether favorable or unfavorable, about me or my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me or my employment.


3. I understand that upon receiving a job offer, a physical examination and drug screening may be required. (Note: If this is a job requirement, you will be notified.)


4. regardless of whether or not I become employed by the company, I recognize that this application is not and should not be considered a contract of employment. I understand that employment at the company is on an at-will basis and that my employment may be terminated with or without cause, and without notice at any time, at my option or the company's, unless specifically provided otherwise in a written employment contract. I further understand that no company employee or representative has the authority to enter into a contract regarding duration or terms and conditions of employment other than a officer or official of the company, and then only by means of a signed, written document.




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