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Click here or scroll down to respond to this candidateCandidate's Name
Application for EmploymentIf you are under Street Address and it is required, can you furnish a work permit Yes No If no, please explain: Have you ever been employed here before? If yes, give dates and positions:_ Yes No Is this application a request for reemployment following an extended military leave of absence from this company Yes No If yes, additional information may be requested.Are you legally eligible for employment in this country Yes No Date available for work What is your desired salary range Type of employment desired: Full-Time Part-Time Temporary Seasonal Educational Co-Op Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)? This question is not designed to elicit information about an applicant&#Street Address ;s disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law. Yes No Need more information about the jobs essential functions to respond Drivers license number required if driving may be required in the job for which you are applying: State_ Answering yes to either part of the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account. Have you ever pleaded guilty or no contest to, or been convicted of, a crime Yes No If yes, please provide date(s) and details:_/ /Position(s) applied for Date of application Name Applicant ID # Address Telephone # Cellular/Other #_ E-mail Address Referral Source (How did you hear about us?) Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department./ / Last First Middle Street City State ZIP CodeEmployment HistoryEmployer Telephone #Street address City StateStarting job title/final job titleImmediate supervisor and title (for most recent position held) May we contact for reference? Why did you leave?Summarize the type of work performed and job responsibilities. Employer Telephone #Street address City StateStarting job title/final job titleImmediate supervisor and title (for most recent position held) May we contact for reference? Why did you leave?Summarize the type of work performed and job responsibilities. Employer Telephone #Street address City StateStarting job title/final job titleImmediate supervisor and title (for most recent position held) May we contact for reference? Why did you leave?Summarize the type of work performed and job responsibilities. Starting with your most recent employer, provide the following information. Yes No LaterE-mail: Yes No LaterE-mail: Yes No LaterE-mail: Month Year Month YearMonth Year Month YearMonth Year Month YearDates employed: / to /Compensation (Starting)Hourly Salary $ perCommission/Bonus/Other Compensation $Compensation (Final)Hourly Salary $ perCommission/Bonus/Other Compensation $Dates employed: / to /Compensation (Starting)Hourly Salary $ perCommission/Bonus/Other Compensation $Compensation (Final)Hourly Salary $ perCommission/Bonus/Other Compensation $Dates employed: / to /Compensation (Starting)Hourly Salary $ perCommission/Bonus/Other Compensation $Compensation (Final)Hourly Salary $ perCommission/Bonus/Other Compensation $Page 1An Equal Opportunity EmployerI certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. 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, resum or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or 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 for me 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 with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or 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 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 employers president. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status. The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly. 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) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employers service, whenever it is discovered. Applicant StatementDO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT. I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement. Signature of Applicant Date / / Starting with your most recent school attended, provide the following information. List names and telephone numbers of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you. Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying:_ Computer Skills (Check appropriate boxes. Include software titles and years of experience.) Word Processing Years:_ E-mail_ Years: Spreadsheet Years:_ Internet_ Years: Presentation Years:_ Other Years: School (include City & State) YearsCompleted Completed GPAClass Rank Major/MinorSkills and QualificationsEducational Background Diploma GED Degree_ Certification Other Diploma GED Degree_ Certification Other Diploma GED Degree_ Certification OtherSS# - - We will use this information only for employment purposes and make reasonable efforts to safeguard your privacy. Social Security NumberReferencesName TitleRelationship Telephone E-mail # of Yearsto You Known This product is designed to provide accurate and authoritative information. However, it is not a substitute for legal advice and does not provide legal opinions on any specific facts or services. The information is provided with the understanding that any person or entity involved in creating, producing or distributing this product is not liable for any damages arising out of the use or inability to use this product. You are urged to consult an attorney concerning your particular situation and any specific questions or concerns you may have. Important note: This is approved for use by the purchaser only. This form may not be shared publicly or with third parties. Page 22012 EDIA2165DL_English |
