Application for Employment

Instructions: Answer all questions.
On the final step you will be required to enter a digital signature which will be binding as your actual signature.
Your electronic signature below indicates your agreement with the following statements.

*Position(s) Applied for * Date of Application

*Address Line 1

Address Line 2

*City *State *Zip

Home Telephone Number Mobile/Other Number

Social Security Date Of Birth Email Address

List all languages you are fluent in

If necessary, best time to call you at home is

May we contact you at work? Yes / No

If yes, work number and best time to call

*Have you submitted an application here before? Yes / No

*Have you ever been employed here before? Yes / No

If yes, give dates and position From To Position

*Are you legally eligible for work in this country? Yes / No

*Date available for work What is your desired salary range?

*Type of employment desired: Full-time / Part-time Temporary

*Have you ever plead "guilty" or "no contest" to, or been convicted of a crime?

(A crime includes petty misdemeanors, misdemeanors, gross misdemeanors and felonies.) Yes / No

If yes, please provide date(s) and details

ANSWERING [YES] TO THESE QUESTIONS DOES NOT AUTOMATICALLY DISQUALIFY YOU FROM A POSITION.
LYING ABOUT YOUR HISTORY DOES DISQUALIFY YOU!
BACKGROUND CHECKS ARE ORDERED ON ALL QUALIFYING APPLICANTS.
FACTORS SUCH AS DATE OF THE OFFENSE, SERIOUSNESS AND NATURE OF THE VIOLATION, REHABILITATION AND POSITION APPLIED FOR WILL BE TAKEN INTO ACCOUNT. USE THIS SPACE TELL US WHY WE SHOULD OVER-LOOK AN INCIDENT AND TRUST THAT YOU ARE NOT PRONE TO REPEAT HISTORY.

Employment History

Provide the following information of your past and current employers, assignments or volunteer activities, starting with the most recent (use additional sheets if necessary). Explain any gaps in employment in comments section below.

Employer

Address

Telephone Number Fax Number

Date of Employment: Starting Ending

Job Title Supervisor's Name

Rate of Pay: Starting Rate Final Rate

Summarize the type of work you did and job responsibilities:

May we contact for reference? Yes / No

Reason for leaving:

Employer

Address

Telephone Number Fax Number

Date of Employment: Starting Ending

Job Title Supervisor's Name

Rate of Pay: Starting Rate Final Rate

Summarize the type of work you did and job responsibilities:

May we contact for reference? Yes / No

Reason for leaving:

Employer

Address

Telephone Number Fax Number

Date of Employment: Starting Ending

Job Title Supervisor's Name

Rate of Pay: Starting Rate Final Rate

Summarize the type of work you did and job responsibilities:

May we contact for reference? Yes / No

Reason for leaving:

Skills and Qualifications

Summarize any special training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying:

Educational Background

List last three (3) schools attended, starting with the last one; List number of years completed; Indicate degree or diploma earned, if any; Grade Point Average; Major field of study .

References:

List name and telephone number 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.

Special Considerations :

List any additional information you would like us to consider
Including why you would like to work for us.

Application Statement

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

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) cancel further consideration of the application, or (ii) immediately discharge me from the employer's service, whenever it is discovered.

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 the information provided by me in this application, resume 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 such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that 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 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 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 without prior notice, and the employer reserves the same right to terminate my employment at any time with or without cause and without 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 employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete E-Verify and an I-9 Form in this regard.

We consider all applicants for positions without regard to race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve/national guard or any other similarly protected status. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria.

I understand I may be required to take a drug test which screens for illegal drug use prior to being appointed to a designated position and periodically during employment. I understand that this is a condition of employment and I will not be hired if I refuse the drug test or if the drug test shows illegal drug use. I understand that drug screen results will be considered confidential.

DO 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.

You are required to enter a digital signature which will be binding as your actual signature. Your electronic signature below indicates your agreement with the preceding statements.

By typing my name in the following box and clicking the "I AGREE and SUBMIT" button, I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.

*Applicant Signature (Name)

Enter the code from the right here :