Employee Application

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Applicant Information

Although all appropriate fields are required, your first and last name and phone number are needed without exception in order to submit form.

First Name *

Last Name *

Street Address

City

State

ZIP

Phone *

E-Mail

Date Available

Desired Salary ($)

Position Applied for

Are you a citizen of the United States?

If no, are you authorized to work in the U.S.?

Have you ever worked for this company?

If yes, when?

Have you ever been convicted of a felony?

If yes, explain:

Education

High School:

City, State:

From:To: Graduated?    Degree:


College:

City, State:

From:To: Graduated?    Degree:


Other:

City, State:

From:To: Graduated?    Degree:

References

Full Name:

Relationship:

Company:

Address:

Phone:


Full Name:

Relationship:

Company:

Address:

Phone:


Full Name:

Relationship:

Company:

Address:

Phone:

Previous Employment

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From:To: Reason for Leaving:

May we contact your previous supervisor for a reference?


Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From:To: Reason for Leaving:

May we contact your previous supervisor for a reference?


Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From:To: Reason for Leaving:

May we contact your previous supervisor for a reference?

Certification and Authorization

The above information is true and correct. I understand that, in the event of my employment by the Company, I shall be subject to dismissal if any information that I have given in this application is false or misleading or if l have failed to give any information herein requested regardless of the time elapsed after discovery.

I authorize the Company to inquire into my educational, professional and past employment history references as needed to research my qualifications for this position. I hereby give my consent to any former employer to provide employment-related information about me to the Company and will hold the Company and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information. I further authorize the Company to obtain any credit and consumer check.

I understand that nothing in this employment application, the granting of an interview or my subsequent employment with the Company is intended to create an employment contract between myself and the Company under which my employment could be terminated only for cause. On the contrary I understand and agree that if hired, my employment will be terminable at will and may be terminated by me or the Company at any time and for any reason. I understand that no person has any authority to enter into any agreement contrary to the foregoing.

If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of Form I-9. By submitting this electronic form, I hereby acknowledge that I have read and agree to the above statements.