Employment Application Job Application An Equal Opportunity Employer We do not discriminate based on race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related information. Please answer each question fully and accurately. No action can be taken on this application until you have answered all questions. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal references or discrimination based upon non-job-related information. Name * Name First Name First Name Last Name Last Name Position Desired * Date Available To Start * Are You Seeking * Full Time Employment Part-Time Employment Temporary Employment Present Street Address * City/State/Zip * Phone * Email Are you 18 Years or Older? * Yes No If hired, can you furnish proof you are eligible to work in the U.S.? * Yes No Have you ever applied here before? * Yes No Have you ever been employed here? * Yes No Have you ever been convicted of any law violation? Include any violation with a plea of “guilty” or “no contest.” (Exclude minor traffic violations. A conviction will not necessarily disqualify an applicant for employment.) * Yes No Are you applying for a Driving Position? * Yes No Drivers License Number State Licensed In Class of License Professional, trade, business, or civic activities and offices held. (Exclude labor organizations and memberships which reveal color, religion, national origin, sex, age, disability, or other protected status.) Have you worked or attended school under any other names? * Yes No If yes, give names Are you presently employed? * Yes No If yes, can we contact your current employer? Yes No Have you ever been fired or asked to resign from a job? Yes No If yes, please explain Please list 3 personal references, not relatives or former employers. * Do you have a resume? * Yes No Upload Your Resume Drop a file here or click to upload Choose File Maximum file size: 52.43MB Education History | Name of school(s), years attended, Diploma/Degree/Certificate, and Subject Studied. What skills or additional training do you have that relate to the job for which you are applying? What machines or equipment can you operate that relate to the job for which you are applying? Employment History | List names of employers in consecutive order with present or last employer first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. Note: A job offer may be contingent upon acceptable references from current and former employers. PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING I hereby certify that the facts and representations set forth in this employment application and resume are true and complete. I understand that the employment status of applicants for all positions may only be determined following the satisfactory completion of a CORI (Criminal Offender Record Information Check) and DMV (Department of Motor Vehicles) background check. I further understand and agree that if employed, false statements on this application, or any accompanying resume or other materials will disqualify me from consideration for employment and will be considered justification for dismissal whenever discovered. I authorize The President of the Company and/or the Office Manger to share relevant CORI/DCF information with my immediate supervisor. Print Name of Applicant * Print Name of Applicant First Name First Name Last Name Last Name Date * Signature * signature keyboard Clear Submit If you are human, leave this field blank.
