ALL POTENTIAL EMPLOYEES ARE EVALUATED WITHOUT REGARD TO
RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, MARITAL OR VETERAN
STATUS, THE PRESENCE OF A NON-JOB RELATED
HANDICAP OR ANY OTHER LEGALLY PROTECTED STATUS. Position Sought: _______________________________________________________________________________ How did you learn about the position? ______________________________________________________________ Name____________________________________________________________________ Date________________ Address__________________________________ City______________________ State________ Zip___________ Home Phone ________________________Office Phone_________________Other Phone_____________________ EmailAddress:___________________________________ Social Security Number:__________________________ List start and end dates you are available. (Please be realistic and specific about the dates)_____________________ Are you currently attending school?_____Date spring term
ends___________Date fall term begins______________ Desired Wage/Salary
$_________________ Have you ever been
involuntarily terminated or asked to resign from any position of employment?
[ ] Yes [ ] No Do you have a valid drivers license? [ ] Yes [ ] No Have you had any accidents in the past three years? [ ] Yes [ ] No If yes, please list occurrences_________________________________________________________________ Have you had any moving violations in the past three years? [ ] Yes [ ] No If yes, please list occurrences_________________________________________________________________
Other training,
certifications, or licenses held:
________________________________________________________ List other information
pertinent to the employment you are seeking:
______________________________________
(Most Recent First.) 1. Employer__________________________________________________ Job Title_________________________ Dates Employed_________________ Prior Position Held within Company (if any): _________________________ Address_______________________________________ City___________________ State________ Zip_________ Phone____________________ Job Title_______________________ Supervisor____________________________ Starting Salary________________________________ Ending Salary____________________________________ Duties Performed ______________________________________________________________________________ Reason for Leaving
_____________________________________________________________________________
2. Employer__________________________________________________ Job Title_________________________ Dates Employed_________________ Prior Position Held within Company (if any): _________________________ Address_______________________________________ City___________________ State________ Zip_________ Phone____________________ Job Title_______________________ Supervisor____________________________ Starting Salary________________________________ Ending Salary____________________________________ Duties Performed ______________________________________________________________________________ Reason for Leaving _____________________________________________________________________________
3. Employer__________________________________________________ Job Title_________________________ Dates Employed_________________ Prior Position Held within Company (if any): _________________________ Address_______________________________________ City___________________ State________ Zip_________ Phone____________________ Job Title_______________________ Supervisor____________________________ Starting Salary________________________________ Ending Salary____________________________________ Duties Performed ______________________________________________________________________________ Reason for Leaving _____________________________________________________________________________
4. Employer__________________________________________________ Job Title_________________________ Dates Employed_________________ Prior Position Held within Company (if any): _________________________ Address_______________________________________ City___________________ State________ Zip_________ Phone____________________ Job Title_______________________ Supervisor____________________________ Starting Salary________________________________ Ending Salary____________________________________ Duties Performed ______________________________________________________________________________ Reason for Leaving _____________________________________________________________________________
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.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
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 an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in 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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