Office/Shop Application For Employment

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of non-job-related medical condition or disability, or any other legally protected status. If due to special needs, you require a reasonable accommodation in either the application process or in your job, please notify your interviewer.


Position(s) Applied For
Date of Application 11/24/2017

How were you referred to us?

Walk-In
Friend   - Name
Advertisement
Where:
Employment Agency
Relative   - Name
Other:

APPLICANT INFORMATION

First Name
Middle Name
Last Name
Address Number:   Street:
City
State
Zip Code
Telephone Number(s)
E-mail Address
Social Security Number


Are you at least 18 years of age?
Yes
No
Have you ever filed an application with us before? If yes, give date:
Yes
No
Have you ever been employed with us before? If yes, give date:
Yes
No
Are you currently employed?
Yes
No
May we contact your present employer?
Yes
No
Do you have a legal right to work in the United States?
Proof of citizenship, immigration status, and identity will be required upon employment.
Yes
No
On what date would you be available for work?
Are you available for work:   Full Time    Part Time   Shift Work   Temporary
Are you currently on "Lay-off" status and subject to recall?
Yes
No
Can you travel if a job requires it?
Yes
No
Have you been convicted of a felony within the last 7 years?
Conviction will not necessarily disqualify an applicant from employment.

If Yes, please explain

Yes
No

EDUCATION

 
High School
Undergraduate College / University
Graduate / Professional
School Name and Location
Years Completed 9    10    11    12   1    2    3    4 1    2    3    4
Diploma / Degree
Describe Course of Study
Describe any specialized training, apprenticeship, skills and extra-curricular activities
Describe any honors you have received
State any additional information you feel may be helpful to us in considering your application

Military Service (DD2141 may be required)
Branch
Rank at Entry
Rank at Discharge
Dates of Service
Position Classification
Specialized Training

List professional, trade, business or civic activities and offices held.
You may exclude memberships which would reueal sex, race, religion, national origin, age, ancestry, or handicap or other protected status:

REFERENCES
Give name, address and telephone number of three references who are not related to you and are not previous employers.

Reference 1
Name:
Address:
Phone Number:
Reference 2
Name:
Address:
Phone Number:
Reference 3
Name:
Address:
Phone Number:

EMPLOYMENT EXPERIENCE
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disability or other protected status.

Employer 1
Employer Name
Address (Street, City, State, Zip)
Telephone Number(s)
Dates Employed From   To
Hourly Rate / Salary Starting   Final
Supervisor
Job Title
Work Performed
Reason for Leaving
Employer 2
Employer Name
Address (Street, City, State, Zip)
Telephone Number(s)
Dates Employed From   To
Hourly Rate / Salary Starting   Final
Supervisor
Job Title
Work Performed
Reason for Leaving
Employer 3
Employer Name
Address (Street, City, State, Zip)
Telephone Number(s)
Dates Employed From   To
Hourly Rate / Salary Starting   Final
Supervisor
Job Title
Work Performed
Reason for Leaving
Employer 4
Employer Name
Address (Street, City, State, Zip)
Telephone Number(s)
Dates Employed From   To
Hourly Rate / Salary Starting   Final
Supervisor
Job Title
Work Performed
Reason for Leaving

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


APPLICANT'S STATEMENT

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I hereby release all employers, schools, and other persons from all liability in responding to inquiries and releasing information regarding my application. This application for employment shall be considered active for a period of time not to exceed 60 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether a position is open or not. If so, a new application will be required.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by the President of this organization.

I certify that the statements I have made on this application are true. In the event of employment, I understand that false or misleading information given in my application may result in disqualification from consideration, or if employed, discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Signature of Applicant:     Date:


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