ࡱ> gif{ X3bjbjzz 5b>+6)6)6)6)6)J)J)J)8)$)J)1B*B*B*B*B*+++1111111$O36*<16)+++++<16)6)B*B*Q1),),),+X6)B*6)B*1),+1),),/0B*ຑr;u+ 01g1010+6+d+6400&+66)0(++),+++++<1<1+F+++1+++++6+++++++++ ':  Employment Application Print Name ______________________________________________________________ Date ___________________ Last First Middle All applicants will receive consideration for employment without regard to race, color, sex, national origin, religion, age, marital status, physical or mental disability, veteran status, or any other prohibited criterion.. [Company Name] offers equal employment opportunity and treatment to all employees and applicants for employment. Position(s) applied for _____________________________________________________________________________ (You must specify the position(s) you are applying for. Applications containing indefinite responses, such as any available position will not be considered). Applicants will remain valid for 60 days, after which you should reapply if you are still interested in a position with our company. Phone ____________________ Other Phone ______________________ Social Sec. No. ________________________ Where you can be located Present address _____________________________________________________________________________________ No. Street City State Zip Previous address ____________________________________________________________________________________ No. Street City State Zip Do you have adequate transportation to work? Yes_____ No_____ Do you have any relatives working for this company? Yes_____ No_____ Does your immigration status permit you to accept employment lawfully, immediately, and indefinitely? Yes___ No___ If not, what must be done in order for you to accept or continue the proposed employment lawfully? _________________________________________________________________________________________________ Have you ever been bonded? Yes_____ No_____ If yes, on what jobs? ____________________________ Have you been convicted of, or pled guilty, no contest to, or received deferred adjudication for a felony or misdemeanor? Yes_____ No______ If yes, describe in full (use additional paper if necessary): __________________ ______________________________________________________________________________________________________________________________________________________________________________________ (A conviction, plea of guilty or no contest, or deferral is not an automatic bar to employment; all circumstances will be considered.) Record of Previous Employment Present Employer (or most recent) ___________________________________________________ Kind of Business __________________ Address ___________________________________________________________________________________________ City _______________________________ State & Zip _________________ Phone ___________________________ Starting date _________________________ Starting title _________________ Starting earnings __________________ Present date _________________________ Present title _________________ Present earnings __________________ Starting duties ______________________________________________________________________________________ Present duties ______________________________________________________________________________________ Last immediate supervisors name and title _______________________________________________________________ What did you like BEST about this job? _________________________________________________________________ What did you like LEAST about this job? ________________________________________________________________ Reason for leaving __________________________________________________________________________________ May we contact your present employer now without jeopardizing your position? _________________________________ Previous Employer _______________________________________________ Kind of Business __________________ Address ___________________________________________________________________________________________ City ________________________________ State & Zip __________________ Phone __________________________ Starting date _________________________ Starting title _________________ Starting earnings __________________ Leaving date _________________________ Leaving title _________________ Leaving earnings __________________ Starting duties ______________________________________________________________________________________ Leaving duties _____________________________________________________________________________________ Last immediate supervisors name and title _______________________________________________________________ What did you like BEST about this job? _________________________________________________________________ What did you like LEAST about this job? ________________________________________________________________ Reason for leaving __________________________________________________________________________________ Previous Employer________________________________________________ Kind of Business __________________ Address __________________________________________________________________________________________ City ________________________________ State & Zip__________________ Phone __________________________ Starting date _________________________ Starting title _________________ Starting earnings __________________ Leaving date _________________________ Leaving title _________________ Leaving earnings __________________ Starting duties ______________________________________________________________________________________ Leaving duties _____________________________________________________________________________________ Last immediate supervisors name and title _______________________________________________________________ What did you like BEST about this job? _________________________________________________________________ What did you like LEAST about this job? ________________________________________________________________ Reason for leaving __________________________________________________________________________________ If more than three previous employers, list others here: Dates From ToCompany and AddressPosition or Type of WorkSalary or WageReason for Leaving--- Please explain fully any gaps in your employment history. ___________________________________________________ What special skills & qualifications do you have? _________________________________________________________ _______________________________________________________________________________________________________________________ What machines or equipment can you operate? ____________________________________________________________ Educational Record SchoolDateName of SchoolCityMajor Course or SubjectDid you graduate?High SchoolCollege or University From ToNight School Business CollegeCorrespondence SchoolOther References (Not employers or relatives -- At least three) Name _______________________________________________________________ Phone ____________________ Address Occupation Name _______________________________________________________________ Phone ____________________ Address Occupation Name _______________________________________________________________ Phone ____________________ Address Occupation Occasionally the form of an application makes it difficult for an individual to adequately summarize his/her complete background. To assist us in finding the proper position for you in our company, use the space below to summarize any additional information necessary to describe your full qualifications. PLEASE READ CAREFULLY BEFORE SIGNING Applicants Certification and Agreement I hereby certify that the information I have provided on this application (and any other document I have provided) is true, correct, and complete. I understand that any falsification, misrepresentation or omission in this application or hiring process will be sufficient grounds for rejection of the application or termination of employment without notice at any time hereafter. I understand that, as part of the pre-employment process, an investigative consumer report may be obtained by the company, including information as to my character, general reputation, personal characteristics and mode of living. Upon my written request, within a reasonable time from the date of this application, additional information as to the nature and scope of the investigation and report, if any, will be provided. I hereby release all persons furnishing information in connection with the investigative consumer report from liability or damages incurred as a result of such an inquiry and furnishing of this information. I herby authorize any and all schools, former employers, references, courts, and any others who have information about me to provide such information to the company and/or any of its representatives, agents, or vendors, and I release all parties involved from any and all liability for any and all damage that may result from providing such information. I understand that if offered a position, I will be required to submit to a pre-employment health survey, which may include drug screening. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employments tests and checks will result in withdrawal of any employment offer or termination of employment if already employed. In consideration for employment by the company, if employed, I agree to conform to the rules, regulations, policies and procedures of the company at all times and understand that such obedience is a condition of employment. If employed, I understand that I retain my normal right to terminate any employment relationship at any time, with or without any notice or reason, and I understand that the company retains the same right. I also recognize that nothing shall alter the terminable-at-will nature of my employment relationship with the company unless it is in writing and signed by the president of the company. I agree that in consideration of my employment with the Company that if I file a lawsuit regarding the conditions of my employment or termination of employment, I will waive my right to a jury trial and that no demand, request or motion will be made for trial by jury. Instead, I agree that the case will be tried to a judge without a jury. 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