Employment Application

BASIC INFORMATION

Applicant Name*

First Last

Date*

Position(s) Desired*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone*

Available Start Date*

Type of Employment Desired*

Full-Time

Part-Time

Temporary

Are you able to meet the attendance requirements?*

Yes

No

Do you have any objection to working overtime if necessary?*

Yes

No

Can you travel if required by this position?*

Yes

No

Have you ever been previously employed by our organization?*

Yes

No

Can you submit proof of legal employment authorization and identity?*

Yes

No

If you are under 18, can you provide a work permit if it is required?

Yes

No

Have you been convicted of a crime in the last 10 years?*

Yes

No

If yes, please explain (a conviction will not automatically bar employment):

Drivers license number (if driving is an essential job duty):

How were you referred to us?

EMPLOYMENT HISTORY

Please provide all employment history for your past three employers, starting with the most recent.

Employer 1*

Position Held*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone*

Immediate Supervisor & Title*

Dates Employed*

Salary*

Job Summary*

Reason for Leaving*

Employer 2

Position Held

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Immediate Supervisor & Title

Dates Employed

Salary

Job Summary

Reason for Leaving

Employer 3

Position Held

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Immediate Supervisor & Title

Dates Employed

Salary

Job Summary

Reason for Leaving

OTHER SKILLS AND QUALIFICATIONS

Summarize any job-related training, skills, licenses, certificates, and/or other qualifications.

EDUCATIONAL HISTORY

List school name and location, years completed, course of study, and any degrees earned.

High School Name*

Address*

City State / Province / Region

Years Completed*

Course of Study*

Degree Earned*

College Name

Address

City State / Province / Region

Years Completed

Course of Study

Degree Earned

Technical School

Address

City State / Province / Region

Years Completed

Course of Study

Degree Earned

Other Educational Institution

Address

City State / Province / Region

Years Completed

Course of Study

Degree Earned

REFERENCES

Reference 1*

Phone*

Years Known*

Reference 2

Phone

Years Known

Reference 3

Phone

Years Known

**We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization.** I hearby authorize the potential employer to contact, obtain, and verify the accuracy of the information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information. I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered. If i am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law. I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA. I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment. I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.

Signature*

Date*

Resume

Max. file size: 2 MB.

Cover Letter

Max. file size: 2 MB.