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APPLICATION FOR EMPLOYMENT

Date: __________________________________

Name: _____________________________________
Address:____________________________________ City:______________________
State:____________ Phone: Home:_______________________________ Phone:

Cell:_________________________________ Social Security

Number:________________________ Are you eligible for employment in this country?
_____________________________________________ Have you been convicted of a
felony/crime in the past seven years?______________________________

Do you have a valid Drivers License?__________ Drivers License

number:________________________

If you are under 18 years of age, can you furnish a work permit?
_________________________________ Have you previously filed an application here
before? _________________________________________ Have you been employed here
before?_____________________________________________________ It is a job requirement
to work nights, weekends and holidays. Are you able to meet this job requirement?
__________________________________________________________________________ Position
you are applying for: _____________________________________________________________
Type of employment desired: Full-time:________ Part-time:________
Temporary/Summer:_________ Desired Hourly Salary:
__________________________________________________________________ Date Available for
work: _________________________________________________________________ Have you
ever been dismissed or resigned from a position?
_____________________________________ How did you learn about the job for which you
are applying?____________________________________ May we contact your previous
employer?___________________________________________________ Please describe any
qualities or experience that would make you a good candidate for employment?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

EDUCATION

High School attended: ________________________________________________

Did you graduate?
_____________________________________________________________________ College or
University attended and other education:

School and Location From To Date Graduated Degree Major Area of Study

EMPLOYMENT HISTORY Please list your last four employers, starting with the most
recent.
Employer: Address:
Telephone number: Supervisor: Job Title: Starting Salary: Final Salary: Job
Description: Dates of Employment: Hours per week: Reason for leaving: Employer:
Address: Telephone number: Supervisor: Job Title: Starting Salary: Final Salary: Job
Description: Dates of Employment: Hours per week: Reason for leaving: Employer:
Address: Telephone number: Supervisor: Job Title: Starting Salary: Final Salary: Job
Description: Dates of Employment: Hours per week: Reason for leaving: Employer:
Address: Telephone number: Supervisor: Job Title: Starting Salary: Final Salary: Job
Description: Dates of Employment: Hours per week: Reason for leaving:
REFERENCES Please do not use family or friends. Name / Title Telephone Number
Years Known

It is understood and agreed upon that any misrepresentation by me in the

application will be sufficient

cause for cancellation of this application and / or separation from the employers
service if I have been

employed. Furthermore, I understand that just as I am free to resign at any time,

the employer reserves the right to terminate my employment at any time without
cause, and without prior notice. I understand that no representative of the employer
has the authority to make any assurances to the contrary. I give the employer the
right to investigate all references and to secure additional information about me, if
job related. I hereby release from liability the employer and its representatives for
seeking such information, and all other persons, corporations or organizations for
furnishing such information. Signature of Applicant:
__________________________________________ Date: __________________
AN
EQUAL OPPORTUNITY EMPLOYER