Date:
Last Four of Social SecurityNO.:
Full Name:
Address/State/Zip:
Phone Number:
Alternative Phone Number:
Email Address:
Are you legally eligible for work in the United States? YesNo
Are you 18 years or older? YesNo
Position applied for:
Referred By:
Ever applied to this Company before? YesNo
If yes, When:
Would you prefer to work: Full TimePart TimeTemporary
Date Available:
Are you Employed now? YesNo
Salary Desired:
US armed forces: YesNo
If yes, Branch:
Have you been convicted of a felony within the past 7 years? YesNo
If yes, please explain:
Person to contact in case of Emergency:
High School:
From:
To:
Did you graduate: YesNo
Degree:
College:
Other:
Company Name:
Address:
Supervisor:
Job Title:
Salary:
Responsibilities:
Start Date:
End Date:
Reason for Leaving:
May we contact your previous supervisor for a reference? YesNo
Please list any additional information that relates to your ability to perform the job for which you have applied, such as special training, machine operations, hobbies, languages, etc.
I CERTIFY THAT THE FACTS SET FORTH IN THIS APPLICATION FOR EMPLOYMENT ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT IF I AM EMPLOYED, FALSE STATEMENTS ON THIS APPLICATION SHALL BE CONSIDERED SUFFICIENT CAUSE FOR DISMISSAL. THIS COMPANY IS HEREBY AUTHORIZED TO MAKE ANY INVESTIGATIONS OF MY PRIOR EDUCATIONAL AND EMPLOYMENT HISTORY.
I UNDERSTAND THAT EMPLOYMENT AT THIS COMPANY IS “AT WILL,” WHICH MEANS THAT EITHER I OR THIS COMPANY CAN TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, WITH OR WITHOUT PRIOR NOTICE, AND FOR ANY REASON NOT PROHIBITED BY STATUTE. ALL EMPLOYMENT IS CONTINUED ON THAT BASIS. I UNDERSTAND THAT NO SUPERVISOR, MANAGER, OR EXECUTIVE OF THIS COMPANY, OTHER THAN THE PRESIDENT, HAS ANY AUTHORITY TO ALTER THE FOREGOING.
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