To be read and signed by the applicant (signature in form)

This application will expire in 30 days. After that date, unless otherwise notified, I understand that my status as an applicant will end. I may re-apply for employment in the future by completing a new application.

This application is not an employment agreement. If I accept an offer of employment I understand I may resign at any time, and the employer may terminate my employment at any time, with or without cause and without prior notice, unless required by law. I understand that no one, other than an executive officer of the employer, has the authority to enter into an employment agreement with terms contrary to the foregoing and then only in writing signed by such officer.

I fully understand and accept all terms and conditions in the above statement and certify that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Contact Information

Name

Phone

Email

Address

Work Authorization

Do you have the legal right to work in the United States?

Yes No

Are 18 years of age?

Yes No

Can you furnish a work permit?

Yes No

Apart from absence for religious observance, are you available for full-time work?

Yes No

Will you work overtime if asked?

Yes No

Employment

Have you worked for this company before?

Yes - if yes answer questions in the following section No - if no please skip next section

Are you currently employed?

Yes No - if no answer the following question

Background

Have you ever been convicted of a felony?

Yes - if so please explain below No

Is there any reason you might be unable to perform the fuctions of the job for which you have applied?

Yes No

Education

School (check all that apply)

Graduate College Business/Trade/Technical High School

Name(s) of school

Course of study

Number of years completed

Did you graduate?

Yes No

Degree or Diploma

Employment History - List most recent first

Employer Name

Employer Address

Contact Person

Phone Number

Dates Employed

Position Held

Salary/Wage

Reason for leaving

Military

Did you serve in the U.S. Armed Forces?

Yes - if yes answer next questions No

In what branch?

Describe any training received relevant to the position for which you are applying.

Signature - Please type your name to be signed by applicant

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