Standard Application for Employment

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications.

Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application. You may attach a resume, but all questions must be answered.

Position applying for *

PERSONAL DATA

Name (last, first, middle) *

Street Address and/or Mailing Address *

City *

State *

Zip *

Home Telephone Number *

Business Telephone Number *

Cellular Telephone Number *

Date you can start work * +

Salary Desired *

Do you have a High School Diploma or GED? *

Yes

No

POSITION INFORMATION (Check all that you are willing to work.)

Hours *

Full Time

Part Time

Times *

Days

Evenings

Shift *

Swing

Graveyard

Weekends

Status *

Regular

Temporary

Are you authorized to work in the U.S. on an unrestricted basis? *

Yes

No

Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.) *

Yes

No

If yes. explain:

Have you been told the essential functions of the job or have you viewed a copy of the job description listing the essential functions of the job? *

Yes

No

Can you perform these essential functions of the job with or without reasonable accommodation? *

Yes

No

I do not know the essential functions

QUALIFICATIONS

Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training.

	School Name	Degree	Address/City/State
School	School Name	Degree	Address/City/State
School	School Name	Degree	Address/City/State
Other	School Name	Degree	Address/City/State

SPECIAL SKILLS

List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.).

REFERENCES

Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don't have three professional references, then list personal, unrelated references.

*

	Name	Address/City/State	Phone	Relationship
1	Name	Address/City/State	Phone	Relationship
2	Name	Address/City/State	Phone	Relationship
3	Name	Address/City/State	Phone	Relationship

WORK HISTORY

Start with your present or most recent employment and work back. Use separate sheet if necessary. (INCLUDE PAID AND UNPAID POSITIONS.)

Job Title #1

Start Date (mo/day/yr)

End Date (mo/day/yr)

Company Name

Supervisor's Name

Phone Number

City

State

Zip

Duties

Reason for leaving

Starting Salary

Ending Salary

May we contact your present employer?

Yes

No

N/A

Job Title #2

Start Date (mo/day/yr)

End Date (mo/day/yr)

Company Name

Supervisor's Name

Phone Number

City

State

Zip

Duties

Reason for leaving

Starting Salary

Ending Salary

Job Title #3

Start Date (mo/day/yr)

End Date (mo/day/yr)

Company Name

Supervisor's Name

Phone Number

City

State

Zip

Duties

Reason for leaving

Starting Salary

Ending Salary

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 am employed, false statements, omissions, or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.

I acknowledge and understand that the company is an "at will" employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.

Date * +

Applicant Signature * 🛈

clear