Application for Employment

We consider applicants for all position without regard to race, color, religion, creed, gender; national origin, age, disability, marital or veteran status, or any other legally protected status.

Position(s) Applied for

Date of application

How did you learn About Us?
Advertisement	Relative	Inquiry
Employment Agency	Friend	Other

Last Name	First Name	Middle Name
Address	Number	Street
City	State	Zip Code
Tel:	Social Security Number

Best time to contact you at home is

If you are under 18 years of age, can you provide required:

Proof of your eligibility to work?

Yes

Have you ever fliled an application with us before?

Yes

If Yes, give date

Date

Have you ever been employed with us before?

Yes

If Yes, give date

Date

Do any of your friends or relative, other then spouse, work here?

Yes

Are you currently employed?

Yes

May we contact your present employer?

Yes

Are you prevented form lawfully becoming employed in this country because of visa or immigration status

Proof of citizenship or immigration status will be required upon employment

Yes

Date available for work

What is your desired salary range?

Are you available to work:
Full-Time	(please indicate shift)
Part-Time	(please indicate Mornings Afternoon Evenings)
Temporary	(please indicated dates available From: To:

Are you currently on lay-off status and subject to recall?

Yes

Can you travel if a job requires it?

Yes

We are an equal opportunity Employer

Education

	Name and address of School	Course of study	Year Completed	Diploma Degree
Elementary school
High School
Undergraduate College
Graduate professional
Other Specify

Describe any specialized training, apprenticeship skills and extra-curricular activities.

Describe any job-related training received in the United State military.

Employment experience

Start with your present or last job. Include any job- related military service assignments and volunteer activities. You may exclude organizations which indicated race, color, religion, gender, national origin, disabilities or other protected status.

1	Employer		Dates Employed		Work performed
	Address		Form	To	Work performed
	Telephone Numbers(s)
	Job Title	Supervisor	Hourly Rate Salary
			Starting	Final
	Reason for Leaving

2	Employer		Dates Employed		Work performed
	Address		Form	To	Work performed
	Telephone Numbers(s)
	Job Title	Supervisor	Hourly Rate Salary
			Starting	Final
	Reason for Leaving

3	Employer		Dates Employed		Work performed
	Address		Form	To	Work performed
	Telephone Numbers(s)
	Job Title	Supervisor	Hourly Rate Salary
			Starting	Final
	Reason for Leaving

4	Employer		Dates Employed		Work performed
	Address		Form	To	Work performed
	Telephone Numbers(s)
	Job Title	Supervisor	Hourly Rate Salary
			Starting	Final
	Reason for Leaving

List professional, trade, business or civic activities and offices held.
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status:

Additional Information

Other Qualification
Summarize special job-related skills and qualifications acquired from employment or other experience.

Specialized Skills (Check Skills/Equipment Operated)

Terminal	Spreadsheet	Production/Mobile Machinery (List)	Other (List)
PC/MAC	Word Processing
Typewriter	Shorthand
WPM	WPM

State any additional information you feel may be helpful to us in considering your application

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING

Are you capable of performing in a reasonable manner, with or without a reasonable accomodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given

Yes No

References

1	Name:		Phone:
	Adderss:

2	Name:		Phone:
	Adderss:

3	Name:		Phone:
	Adderss:

Applicant's Statement

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understood and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an at will nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is futher understood that this at will employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, i understand that false or misleading informatino given in my application or interview(s) may result in discharge. I understand, also, that i am requierd to abide by all rules and regulations of the employer.