Personal Information

Position applying for:

First Name:   Last Name:   Middle:   Phone:

Address:     City:   State:      Zip:

Email:

Are you 16 or older? Yes   No        Are you 18 or older?   Yes   No

Have you ever been convicted of a crime, excluding misdemeanors and traffic violations?  Yes   No

If yes, describe in full:

When would be the best time to call you at the above phone number?

Work Availability

Type of employment desired:  Full-time   Part-time                        Date Available to work:

Number of hours available per week:                            

Specify the days and the time each day you would be available to work:

Monday              

Tuesday           

Wednesday      

Thursday          

Friday              

Saturday          

Sunday            

Do you have any commitments to another employer that might affect your employment with us?  Yes    No

Are you legally eligible for employment in this country (a US citizen or alien authorized to work in the United States)?:   Yes    No

Educational History

Click on the last grade completed in high school:  8th grade or less    9th    10th    11th    12th    GED

Name and location of school: 

Click on last year of college: 1st Year   2nd Year    3rd Year    4th year    Beyond 4 years

Did you graduate? Yes    No       If Yes, where?      Major Study:

Name and Location of College: 

Phone #:             Supervisor's name and title:   

Employment dates:            Position held: 

Reason for leaving:

2.  Company Name:                Company Address: 

Phone #:             Supervisor's name and title:   

Employment dates:            Position held: 

Reason for leaving:

3.  Company Name:                Company Address: 

Phone #:             Supervisor's name and title:   

Employment dates:            Position held: 

Reason for leaving:

Have you ever been disciplined for absenteeism or tardiness?  Yes  No

What other special qualifications do you have not listed above? 

Briefly state why you would like to work for this company:

IMPORTANT, PLEASE READ CAREFULLY

    We are an equal employment opportunity company.  We are dedicated to a policy of non-discrimination in employment on any basis including race, creed, age, sec, religion, national origin, height, weight, marital status or disability.

    I understand that to be employed I must be lawfully authorized to work in the United States and be able to show the employer documents to prove this.

    I understand that the company will thoroughly authorize investigate my work and personal history and verify all data given on this application, on related papers, and in interviews.  I authorize all individuals, schools, and firms named therein, except my current employer if so noted, to provide any information requested about me, and I release them from all liability for damage in providing this information.  I authorize the company to secure records regarding my criminal conviction history from the appropriate law enforcement agencies.

    All of the information on this application and made in conjunction with this application is correct and true to the best of my knowledge.  I understand that any false or misleading statements made by me in connection with this application or the failure to disclose any material information will be grounds for immediate dismissal.

    In consideration of my employment, I agree to conform to the rules and regulations of this company, and my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the discretion of either the company or myself.  I understand that no manager or representative of this company, other than the president/owner of the company, has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.

    Signature:                    Date:

    DON'T FORGET TO TYPE IN YOUR NAME AND THE DATE BEFORE SUBMITTING THE APPLICATION!!