General
Information
* First
Name: * Last
Name:
* Middle
Initial:* Phone:
* E-mail:* Address:
* City:* State:
* Zip
code:
* Are
you legally entitled to work in the U.S.?
Yes
No
* Have
you ever pled “guilty” or “no
contest” to, or been convicted of
a crime?
No
Yes
Position
* Position
Or Type Of Employment Desired:
* Are
you able to perform the essential functions
of the job you are applying for, with or
without reasonable accommodation?
Yes
No
* Salary
Desired:* Date
Available:
Education
and Training
* High
School Graduate Or General Education (GED)
Test Passed?
Yes
No
College, Business
School, Military (Most recent first)
Veteran
Information
Branch of Service:
Date of Entry:
Date of Discharge:
Special
Skills (List all pertinent skills and equipment
that you can operate)
Work
Experience (Most Recent First) (Include
voluntary work and military experience)
I certify the information
contained in this application is true, correct,
and complete. I understand that, if employed,
false statements reported on this application
may be considered sufficient cause for dismissal.
* Signature:* Date:
I
understand that any information provided
by me that is found to be false, incomplete,
or misrepresented in any respect, will
be sufficient cause to (i) cancel further
consideration of this application, or
(ii) immediately discharge me from the
employer’s service, whenever it
is discovered.
I expressly authorize, without
reservation, the employer, its representatives,
employees or agents to contact and obtain
information from all references (personal
and professional), employers, public agencies,
licensing authorities and educational
institutions and to otherwise verify the
accuracy of all information provided by
me in this application, resume or job
interview. I hereby waive any and all
rights and claims I have regarding the
employer, its agents, employees or representatives,
for seeking, gathering and using such
information in the employment process
and all other persons, corporations or
organizations for furnishing such information
about me.
I understand that the employer
does not unlawfully discriminate in employment
and no questions on this application are
used for the purpose of limiting or excusing
any applicant from consideration for employment
on a basis prohibited by applicable local,
State, and Federal law.
I understand that this application
remains current for only 30 days. At the
conclusion of that time, if I have not
heard from the employer and still wish
to be considered for employment, it will
be necessary to reapply and fill out a
new application.
If I am hired, I understand
that I am free to resign at any time,
with or without cause and without prior
notice and the employer reserves the same
right to terminate my employment at any
time, with or without cause and without
prior notice, unless otherwise required
by law. This application does not constitute
an agreement or contract for employment
for any specified period or definite duration.
I understand that no supervisor or representative
of the employer is authorized to make
any assurances to the contrary and that
no implied, oral or written agreements
contrary to the foregoing express language
are valid unless they are in writing and
signed by the employer’s president.
I also understand that if
I am hired, I will be required to provide
proof of identity and legal authority
to work in the United States and that
federal immigration laws require me to
complete an I-9 Form in this regard.
