Employee Application

Step 1 of 6

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Name(Required)

First Last

SSN(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Referral Source(Required)

Walk-In

Employee

Company's Website

Other Internet

School

Job Fair

Staffing Agency

Government Employment Agency

Other

Referral Name

If necessary, best time to call you at home is:(Required)

Hours

Minutes

AM/PM

Have you submitted an application here before?(Required)

Yes

May we contact you at work?(Required)

Yes

If Yes, date and position(s)(Required)

MM slash DD slash YYYY

Position(s)(Required)

If yes, what is your work number?(Required)

Have you ever been employed here before?(Required)

Yes

Best time to call at work?

Hours

Minutes

AM/PM

if yes, Start Date(Required)

MM slash DD slash YYYY

End Date(Required)

MM slash DD slash YYYY

If no, Please Explain:

Section Break

Are you legally eligible for employment in this country(Required)

Yes

Will you work overtime if required?(Required)

Yes

Date available for work(Required)

MM slash DD slash YYYY

Please explain(Required)

Desired Salary Range(Required)

Ex.) $7.25/hr

Driver's license(Required)

ID number required if driving may be required in the job for which you are applying

State(Required)

Type of employment desired(Required)

Full Time

Part Time

Seasonal

Temporary

Will you relocate if the job requires it?(Required)

Yes

Will you travel if job requires it?(Required)

Yes

Have you ever been bonded?(Required)

Yes

Answering "yes to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be take into account.

Have you ever pled "guilty" or "no contest" to or been convicted of a crime?(Required)

Yes

Please provide date(s) and detail(s)(Required)

Employment History

Employer	Start Date	End Date	Actions

There are no Jobs.

Maximum number of jobs reached.

Employment History Continued

Explain any gaps in your employment, other than those due to personal illness or injury or disabilities:

If not addressed on previous page, have you ever been fired or asked to resign from a job?(Required)

Yes

Please explain(Required)

Skills & Qualifications

Summarize any special training, skills, licenses and/or certificate that may assist you in performing the position for which you are applying

Computer Skills

Word Processing

Spreadsheets

Presentation

E-mail

Internet

Other

Include any software titles and years of experience

Educational Background

Starting with your most recent school attended, provide the following information

School(Required)

Did you complete?(Required)

Yes

Level of accomplishment(Required)

School

Did you complete?

Yes

Level of accomplishment

School

Did you complete?

Yes

Level of accomplishment

School

Did you complete?

Yes

Level of accomplishment

References

List name and telephone number of three business/work references who are NOT related to you and are NOT previous supervisors. If not applicable, list three school or personal references who are NOT related to you.

Name(Required)

Length of relationship(Required)

Telephone(Required)

Relationship(Required)

Name(Required)

Length of relationship(Required)

Telephone(Required)

Relationship(Required)

Name(Required)

Length of relationship(Required)

Telephone(Required)

Relationship(Required)

Related Information

To what job-related organizations (professional, trade, etc.) do you belong? *Excluding memberships that would reveal race, color, religion, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similar protected status.*

Organization

Offices Held

Organization

Offices Held

Organization

Offices Held

List Special Accomplishments, publication awards, etc.

*Excluding memberships that would reveal race, color, religion, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similar protected status.*

In your current or prior job, have you ever written instructions or directions to be followed by employees or customers?

Yes

Please explain:

Is there any other job-related information you want us to know about you?

Consent(Required)

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.
I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment for employment on any basis prohibited by applicable local, state or federal law.
In understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.
if I'm hired, I understand that I'm free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make assurance to the contrary and that no implied oral or written agreements contrary to the foregoing expressed language and valid unless that are in writing and signed by the employer's president.
I understand that during the first ninety (90) days of my employment, I am on probation. This is considered an initial trial period during which time I can make a trial evaluation of my skills on the job to ascertain my qualifications for further employment with the company. At any time during the 90-day period, either the company, or the employee is free to terminate the probationary employment without prejudice.
I also understand that if I am hired, I wil be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

Signature of Applicant(Required)

First Last

Date(Required)

MM slash DD slash YYYY