CAP - Application for Employment
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Email *
Position Applying for *
Full Name *
Address *
Preferred Contact Number *
Email Address *
Type of Employment *
Required
Date Available to Start *
MM
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Is there any potential historical information you would like to disclose that may be revealed during the background process?  *
If "Yes", please explain.
Referral Source *
If you were referred by an employee please include their name here:
Employment History:
Employer 1 /Phone
 *
Current Employer? *
Required
Employer 1 Address + City, State and Zip Code *
Employer 1 Job Title: *
Employer 1 Start/End Date:
Reason for leaving
 *
 May we contact Employer 1 for reference? *
Summarize the type of work performed and job responsibilities for Employer 1. *
Employment History:
Employer 2 /Phone
Employer 2 Job Title:
Employer 2 Start/End Date:
Reason for Leaving
 *
 May we contact Employer 2 for reference?
Clear selection
Summarize the type of work performed and job responsibilities for Employer 2.
Employment History:
Employer 3 /Phone
 *
Employer 3 Job Title:
Employer 3 Start/End Date:
Reason for Leaving
 May we contact Employer 3 for reference?
Clear selection
Summarize the type of work performed and job responsibilities for Employer 3.
Educational Background:
School Attended 1:
 *
School 1
Dates Attended (mm/dd/yyyy - mm/dd/yyyy)
Year Graduated (yyyy)
Major
Type of Degree
 *
Educational Background:
School Attended 2:
 *
School 2
Dates Attended (mm/dd/yyyy - mm/dd/yyyy)
Year Graduated (yyyy)
Major
Type of Degree
 *
References:
List the name, email, phone number of 3 business/work references who are not related to you. Include number of years known for each. 

Professional Reference 1 
 *
References:
List the name, email, phone number of 3 business/work references who are not related to you. Include number of years known for each. 

Professional Reference 2
 *
References:
List the name, email, phone number of 3 business/work references who are not related to you. Include number of years known for each. 

Professional Reference 3
 *

I understand that if I am employed, any misinterpretation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer's service, whenever it is discovered.

I give the employer the right to contact and obtain information from all references, employers, educational institutions, and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering, and using such information and all other persons, corporations or organizations for furnishing such information.

The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law.

This application is current for 60 (sixty) days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to 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, except as may be 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 representative of the employer, other than an authorized officer, has the authority to make any assurance to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer.

I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA.

I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

Entering your name below will have the same legal impact as your signature.

 *
Today's Date: *
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