Application Statement

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resumé or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status. The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.

 

PERSON INFORMATION
Name *
Name
Address *
Address
Home Phone
Home Phone
Mobile Phone
Mobile Phone
If you are under 18 and it is required, can you furnish a work permit? *
Have you been employed here before? *
Are you legally eligible for employment in this country? *
Date available for work: *
Date available for work:
$
Type of employment desired: *
Are you able to perform the essential functions of the job for which you are applying (with or without resonable accommodation)? *
This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.
EMPLOYMENT HISTORY
Employer #1 - Address:
Employer #1 - Address:
Start Date (Month/Day/Year) to End Date (Month/Day/Year)
Employer #1 - Compensation (Starting)
Amount Per Month/Year (Please State)
$
$
Employer #1 - Compensation (Final)
Amount Per Month/Year (Please State)
$
$
Employer #1 - May we contact for reference?
Employer #2 - Address:
Employer #2 - Address:
Start Date (Month/Day/Year) to End Date (Month/Day/Year)
Employer #2 - Compensation (Starting)
Amount Per Month/Year (Please State)
$
$
Employer #2 - May we contact for reference?
Employer #3 - Address:
Employer #3 - Address:
Start Date (Month/Day/Year) to End Date (Month/Day/Year)
Employer #3 - Compensation (Starting)
Amount Per Month/Year (Please State)
$
$
Employer #3 - May we contact for reference?
SKILLS & QUALIFICATIONS
Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying:
Computer Skills (Check appropriate boxes. Include software titles and years of experience.)
Number of Years
Number of Years
Number of Years
Number of Years
Number of Years
Description & Number of Years
EDUCATIONAL BACKGROUND
Starting with your most recent school attended, provide the following information.
Include City & State
Number of Years
Include City & State
Include City & State
REFERENCES
List the name and telephone number of three business/work references.
Reference #1 - Phone Number
Reference #1 - Phone Number
Reference #2 - Phone Number
Reference #2 - Phone Number
Reference #3 - Phone Number
Reference #3 - Phone Number
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered. I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement. *
Do Not Select Until You Have Read The Above Applicant Statement and Agree To These Terms.