Application for Employment
Name: (First, Last, Middle)
Social Security #:
Address:
City:
State:	Zip:
Phone:
Email:

Are you 18 years or OLDER?
Yes No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Yes No

Have you ever been convicted of a felony or misdemeanor?
Yes No

Employment Desired

Position

(Choose one) Full Time   Part Time

Shift
1st Shift    2nd Shift    3rd Shift

Start Date

Salary

Are you currently employed?
Yes No

If so may we inquire of your current employer?

Have you ever worked for this company before?
Yes No

Where?

When?

Referred by?

Education

Grammer School
(Name and Location of School, # of Years Attended, Did you Graduate, Subjects Studied?)

High School
(Name and Location of School, # of Years Attended, Did you Graduate, Subjects Studied?)

College
(Name and Location of School, # of Years Attended, Did you Graduate, Subjects Studied?)

Trade or Business
(Name and Location of School, # of Years Attended, Did you Graduate, Subjects Studied?)

Subjects of Special Study or Research Work

Special Skills

Activities (Civic, Athletic, Etc.)
(Exclude organizations, the name of which indicates the Race, Creed, Sex,
Age, Marital Status, Color or Nation of Origin of its Members)

U.S. Military or Naval Service (Rank, Present Membership in National Guard or Reserves)

Former Employees
(List below the last three employers, starting with the last one first)

Employer #1
(Please indicate date started, date ended, name and address
of employer, your salary, your position and your reason for leaving)

Employer #2
(Please indicate date started, date ended, name and address
of employer, your salary, your position and your reason for leaving)

Employer #3
(Please indicate date started, date ended, name and address
of employer, your salary, your position and your reason for leaving)

Which of these jobs did you like best?

What did you like most about this job?

References
(Give the names of three people not related to you,
whom you have known for at least one year)

Reference #1
(Please indicate Name, Address, Business and Years Aquainted)

Reference #2
(Please indicate Name, Address, Business and Years Aquainted)

Reference #3
(Please indicate Name, Address, Business and Years Aquainted)

In case of Emergency Notify
Name:
Address:
City:
State:	Zip:
Phone:

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions or misrepresentations are discovered, my application may be rejected and if I am employed, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to the company's rules and regulations and I agree that my employment and compensation can be terminated, with or without cause and with or without notice, at any time at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice at any time by the company. I understand that no company representative, other than it's president and only then when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.