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Employment Application

June 04, 2024

We consider applications for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, sexual orientation, citizenship status, genetic information or any other legally protected status.

POSITION INFORMATION

Position(s) Applied For: * 

Type of Employment Desired*    Hours of work (per week) desired*  

Date Available for Work*         What is your desired salary range?*  

How did you hear about the position? Advertisement, Friend, Inquiry, Employment Agency, or Please Specify:*

 

PERSONAL INFORMATION

First Name*  Middle Name*  Last Name* 

Address1* 

Address2  

City*  State*  Zip* 

Phone Number* (XXX-XXX-XXXX)  Email Address*  

ADDITIONAL INFORMATION

Best time to contact you? 

If you are under 18 years of age, can you provide required proof of your eligibility to work?* 

Have you ever filed an application with us before? If Yes, give date*  Date of previous application: 

Have you ever been employed with us before? If Yes, give date*  Date of previous application: 

Do any of your friends or relatives, other than spouse, work here? *  

If Yes: Name, Relationship and Location  

Are you currently employed? *  

May we contact your present employer? *  

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? *  
*Proof of citizenship or immigration status will be required upon employment.

Are you currently on 'lay-off' status and subject to recall?*  

Can you travel if the job requires it? *  

Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation? *  

State any additional information you feel may be helpful to u.s in considering your application, including any job related training in the U.S. Military.

 

EDUCATION

High School Name  

Address 

Course of Study  Number of Years Completed  Degree 

 

Undergraduate College Name  

Address 

Course of Study  Number of Years Completed   Degree 

 

Graduate/Professional Name  

Address 

Course of Study  Number of Years Completed    Degree 

 

Other  

Address 

Course of Study  Number of Years Completed Degree 

EMPLOYMENT EXPERIENCE 

(Start with your present or last job. Include any job-related miliary service assignments and volunteer activities. Exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.) Please email test@test.com with additional employment experience if needed.

Company  Position 

Supervisor  Phone 

May we contact your previous supervisor for a reference? 

Address 

Responsibilities

Employed From - To (Date)    

 

Company  Position 

Supervisor  Phone 

May we contact your previous supervisor for a reference? 

Address 

Responsibilities

Employed From - To (Date) 

 

Company  Position 

Supervisor  Phone 

May we contact your previous supervisor for a reference? 

Address 

Responsibilities

Employed From - To (Date)  

 

WRITING SAMPLE

Please tell us why you are interested in this position and what assets you could bring to it:* 

REFERENCES

Please list three professional references. Do not include family members or past supervisors.

Full Name*        Phone Number*   

Occupation*     Best Time to Call* 

 

Full Name*           Phone Number* 

Occupation*     Best Time to Call* 

 

Full Name*           Phone Number* 

Occupation*     Best Time to Call* 

 

APPLICANT'S STATEMENT

I certify that answers given herein are true and complete.

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.

In the event of employment, I understand that false or misleading information given on 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.

Applicant Signature*   *