Employment Application
Equal Opportunity Employer
We consider applicants for all positions without regard to race, color, religion, sex, sexual orientation, national origin, age, marital, veteran, or socio-economic status, the presence of a non-job-related medical condition, genetics, or disability, or any other legally protected status.
Employment-At-Will
All employment arrangements are strictly at will. This means both the employee and Excel Employment Options have the right to terminate the employment agreement, at any time, with or without cause or notice.
Date of Application:
MM
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DD
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YYYY
Position(s) Applying for:
Referred By:
If current employee, please name:
Your answer
Applicant Information
Last Name:
Your answer
First Name:
Your answer
Street Address:
Your answer
City:
Your answer
Zip Code:
Your answer
Primary Phone:
Your answer
Secondary Phone:
Your answer
Email address:
Your answer
Social Security Number:
Your answer
If under 18 years old, can you furnish a work permit?
If yes, list permit date:
Your answer
Have you applied to Excel before?
If yes, list date(s) applied here:
Your answer
Have you worked for Excel before?
If yes, list start and end dates:
Your answer
Are you looking for full-time or part-time work?
What date would you be available to work?
MM
/
DD
/
YYYY
Are you willing to travel if the job requires it?
Do you have any physical limitations that may preclude you from any work for which you are applying for?
If yes, please explain:
Your answer
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
Have you been convicted of any felonies in the past?
If yes, please explain:
Your answer
Check all training you have completed:
Education
Name of High School:
Your answer
City, State
Your answer
Last grade completed::
Date Diploma/GED received:
Your answer
Name of College/University
Your answer
Course of study:
Your answer
Years attended:
Your answer
Degree earned:
Your answer
Date degree received:
Your answer
Describe additional specialized training, apprenticeships, skills and/or extra curricular activities through school:
Your answer
Current/Most Recent Employment
Name of current or most recent place of employment:
Your answer
Street address:
Your answer
City, State, Zip
Your answer
Telephone:
Your answer
Dates employed:
Your answer
Job Title:
Your answer
Hourly Rate/Salary:
Your answer
Name of Supervisor:
Your answer
Reason for leaving:
Your answer
May we contact this employer?
Additional Employer #1
Employer Name:
Your answer
Street Address:
Your answer
City, State, Zip
Your answer
Additional Employer 1 Telephone:
Your answer
Dates employed:
Your answer
Job Title:
Your answer
Hourly rate/salary:
Your answer
Supervisor:
Your answer
Reason for leaving:
Your answer
May we contact this employer?
Additional Employer # 2:
Employer Name:
Your answer
Street Address:
Your answer
City, State, Zip
Your answer
Additional Employer 2 Telephone:
Your answer
Dates employed:
Your answer
Job Title:
Your answer
Hourly rate/salary:
Your answer
Supervisor:
Your answer
Reason for leaving:
Your answer
May we contact this employer?
Additional Experience
Summarize any special skills, experience or qualifications that would help you with the job you are applying for:
Your answer
References
List the name, address and phone number for 3 references who are not related to you, or are not previous employers
Name:
Your answer
Relationship:
Your answer
Street Address:
Your answer
City, State, Zip
Your answer
Reference 1 Phone:
Your answer
Name:
Your answer
Relationship:
Your answer
Street Address:
Your answer
City, State, Zip
Your answer
Reference 2 Phone:
Your answer
Name:
Your answer
Relationship:
Your answer
Street Address:
Your answer
City, State, Zip
Your answer
Reference 3 Phone:
Your answer
Applicant Statement
I certify that the answers given herein are true and complete to the best of my knowledge.

I hereby give you my permission to contact the above employers, references, and educational, licensing, credentialing and certification institutions to verify the items listed above. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application shall be considered active for a period of time not to exceed one year. If I wish to be considered for employment beyond this time period, I should inquire as to whether or not applications are being accepted at the time.

I understand that neither this document nor any offer of employment from the employer constitutes an employment contract unless the employer and employee in writing execute specific document to that effect.

In the event of employment, I understand that false or misleading information given in my application or in any interview(s) or pre-employment process are grounds for disqualification or termination of employment if discovery is made after employment begins. I understand, also, that I am required to abide by all rules and regulations of the employer.


Signature (Electronic):
Typing my name below indicates that I agree with the Applicant Statement above
Your answer
Problem Solving Scenerios
Please give a brief description of how you would handle the following situations:
You have been coaching Mary for two weeks and she still comes to work with body odor and unwashed hair. You have already given her feedback regarding personal hygeine and have spoken to her family, who have assured you they would take care of it at home. What will you try next?.
Your answer
George works in a department store as a freight elevator operator. It's his 5th day on the job and he still requires some verbal and physical assistance from you to complete his duties. Right now, one of the sales clerks is yelling at George because he delivered a rack of dresses to the wrong floor. What would you do?
Your answer
Michelle is quiet and doesn't leave home often. She is not involved in any activities and has no personal relationships. Michelle claims she has no interests and seems unhappy with her life. How would you assist Michelle in recognizing and developing areas of interest?
Your answer
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