Job Application Form

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Name *

First and last name

Address *

Email *

Phone number *

18 or older *

Yes

IF HIRED, CAN YOU SHOW PROOF OF YOUR LEGAL RIGHT TO WORK IN THE UNITED STATES? *

Yes

HAVE YOU EVER BEEN DISMISED OR ASKED TO RESIGN FROM ANY POSITION? *

Yes

HAVE YOU EVER BEEN CONVICTED OF A FELONY, OR A MISDEMEANOR WHICH RESULTED IN IMPRISONMENT? *

Yes

IF YES TO NUMBER 2 OR 3 ABOVE, PLEASE EXPLAIN *

EMPLOYMENT DESIRED

POSITION *

DATE YOU CAN START *

YYYY

SALARY DESIRED

ARE YOU CURRENTLY EMPLOYED? *

YES

IF SO, WHEN CAN YOU START? *

YYYY

HAVE YOU EVER APPLIED TO ·THIS COMPANY BEFORE? *

YES

IF SO, WHEN?

YYYY

REFERRED BY

EDUCATION *

HIGH SCHOOL/GED

COLLEGE

TRADE SCHOOL

MILITARY/NAVEL SERVICE

Required

NAME OF HIGH SCHOOL

DID YOU GRADUATE?

YES

Clear selection

NAME OF COLLEGE

DID YOU GRADUATE?

YES

Clear selection

NAME OF TRADE SCHOOL

DID YOU GRADUATE?

YES

Clear selection

RANK OF SERVICE

GENERAL SKILL SET *

FORMER EMPLOYERS (LIST YOUR LAST FIVE EMPLOYERS, STARTING WITH LAST ONE FIRST.) *

START AND END DATES (MONTH/YEAR) *

NAME AND ADDRESSES OF LAST FIVE EMPLOYERS *

SALARIES, POSITIONS, AND REASONS FOR LEAVING *

REFERENCES: GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR, PHONE NUMBERS, WHAT BUSINESS, AND YEARS KNOWN *

I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME.

YES

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS HEREIN RECORDED AND I RELEASE FROM LIABILITY ALL PERSONS AND ORGANIZATIONS REPORTING INFORMATION REQUIRED BY THIS APPLICATION.

YES

IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES, REGULATIONS, AND PROCEDURES WHICH MAY BE UPDATED AT ANY TIME. I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITlONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY.

YES

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