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Employment Application

Application Date: 2018-12-16 08:49:05
THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 years.
Personal Information
Street* City* State* Zip Code*
Current Address *
School Attended City State Diploma Degree/Cert. Area of Study
High School H.S. GED
Undergrad School
Grad School
Other School
Employment Information
Position Applied For Date You Can Start Calendar (yyyy-mm-dd) Desired Salary: $
Please answer all of the following questions.
1. Are you a citizen of the United States?
If no, are you authorized to work in the U.S.?
2. Have you ever worked for this company?
If yes, please provide dates:
3. Do you understand the job requirements?
If no, please explain.
4. Have you ever been discharged or asked to resign from a job?
If yes, please explain...
5. Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?
If yes, please explain...
Employment History
Are you currently employed?
May we contact your present employer?
Are you currently employed?
Most Recent Employer Prior Employer Prior Employer Prior Employer
Zip Code
Position Held
From (m/yyyy)
To (m/yyyy)
Pay upon leaving
Reason For Leaving
Military Service
Please complete the information below if you have served in any branch of the U.S. Military
1. Have you served in the U.S. Military?
A. If yes, what branch of service did you serve in?
B. Dates of military service:
2. Were you honorably discharged?
If other than honorable, explain:
3. Rank at Discharge:
Reference (1) Reference (2) Reference (3) Reference (4)
Years Acquainted
Job Related Skills
Please use this space to list any special skills you may have that relate to the position applied for
Upload File
Attach a file to your application submission (Permitted File Types: doc,docx,pdf,txt - Max file size: 1045876 bytes)
Applicant Certification Agreement
1. The company and other persons or employers are released from all liability brought forth by any investigation resulting from my submission of this electronic application and the data contained here in.
2. The information in this application is true and complete to the best of my knowledge. Any falsification, misrepresentation, or omission on this application can be cause for denial or termination of employment.
3. If hired, my employment is voluntary, meaning that either party can terminate employment at any time for any reason. Upon acceptance of employment if a position is offered, I agree to abide by all existing and future company rules and regulations. The company reserves the right to change any working agreement as deemed necessary.
4. Any employment offer is contingent upon my providing proof of identity and eligibility to work in the United States of America.
5. I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.
6. I understand that by typing my name in the signature box below and submitting this application electronically, this becomes a legal and binding contract.
Security Code
Type Name in Signature Box*: