Employment Application Form
Employment Application Form
INSTRUCTIONS:
If you need help to fill out this application form or for any phase of the employment process, please notify the person that gave you this form and every effort will be made to accommodate your needs in a reasonable amount of time.

1. Please read "APPLICANT NOTE."

2. Complete both sides of this form.

3. Print clearly: incomplete or illegible applications will not be processed.

4. Do not fill out any other attached forms until instructed.

APPLICANT NOTE
This application form is intended for use in evaluating your qualifications for questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, color, age, creed, religion, national origin, the presence of disabilities, sexual orientation, status with regards to public assistance, or any other characteristic protected by law. A felony conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills and for the presence of drugs may be required prior to employment. After an offer of employment, and prior to reporting to work, you may be required to submit to a medical review. Depending on company policy and the needs of the job, you may be required to complete a medical history form and may be required to be examined by a medical professional designated by the company. This application applies only to the position specified. It is considered inactive after _____ days. If at any time you wish to be considered for employment within this company, another application must be completed.
Today's Date:
MM
/
DD
/
YYYY
First Name:
Your answer
Last Name:
Your answer
Middle Name:
Your answer
Home Phone:
Your answer
Work Phone:
Your answer
Current Address:
Your answer
AVAILABILITY
For which position are you applying?
Your answer
Are you legally able to work in the United States?
Are you under the age of 18?
What date can you start?
MM
/
DD
/
YYYY
For which schedules are you available?
EDUCATION
Please select the highest grade completed
High School
Name
Your answer
City/State
Your answer
Graduate?
Your answer
College
Name
Your answer
City/State
Your answer
Graduate?
Your answer
Other
Name
Your answer
City/State
Your answer
Graduate?
Your answer
SECURITY
Have you been convicted of a felony and/or served time in the past seven years?
If so, please describe below. (In accordance with company policy this information will be reviewed for job relatedness and time since last conviction and will not necessarily affect your eligibility to be hired.)
Incident
Your answer
City/State
Your answer
Charge
Your answer
JOB RELATED SKILLS
NOTE: Do not fill out any part of this section you believe to be non-job related. Please exclude any information indicative of age, sex, religion, national origin, or disability.
If the job requires, do you have the appropriate valid driver's license?
DL#
Your answer
Type
Your answer
State of Issue
Your answer
Have you had any moving violations?
Please describe if any
Your answer
Please list any other skills, licenses or certificates that may be job-related or that you feel would be of value to this job or company.
Your answer
EMPLOYMENT REFERENCES
Your application will not be considered unless every question is answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are critical
Most Recent Employer
Are you currently working for this employer?
If yes, may we contact your current employer?
Company Name
Your answer
City
Your answer
State
Your answer
Phone Number
Your answer
From (mon/yr)
Your answer
To (mon/yr)
Your answer
Job Title
Your answer
Supervisor's Name
Your answer
Duties
Your answer
Pay
Your answer
REFERENCES
Include only individuals familiar with your work ability. Do not include relatives.
Reference 1
Name
Your answer
Address/Phone
Your answer
Years Known/Relationship
Your answer
Reference 2
Name
Your answer
Address/Phone
Your answer
Years Known/Relationship
Your answer
CERTIFICATION
I certify that I have read and understand the applicant note above this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omission or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I also understand that the use of illegal drugs I prohibited during my employment. If company policy requires, I am willing to submit to a drug testing to detect the use of illegal drugs prior to and during employment. I agree that if I am employed, my employment shall not be construed as being for any definite period of time, but will be for an indefinite period, terminable at will by Company or me.
RELEASE
Signing certifies and authorizes the company and/or its agents including consumer reporting bureaus to verify any of this information including, but not limited to criminal history and motor vehicle driving records. I authorize all persons, school, companies, former employers and law enforcement authorities to release any information concerning my background and hereby release any said persons, school, companies, former employers and law enforcement authorities from any liability for any damage whatsoever for issuing this information.
Applicant's Name
First Name
Your answer
Last Name
Your answer
Dated
MM
/
DD
/
YYYY
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