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Employment Application Form

All applicable information is required. Applicants may be tested for illegal drugs.

Personal

First Name

Last Name

Middle Initial

Social Security No.

Telephone No.

Cell Phone No.

Address

City

State

Zip

Are you over the age of 18? If no, hire is subject to verification that you are of minimum legal age.
Yes No

Position applied for

Salary desired

What date will you be available to work?

Have you ever been convicted of a crime?
Yes No

If yes, please give the conviction date and nature of the offense.

Do you have a driver's license?
Yes No

Driver's license No.

State of issue

Expiration date

Personal References (not former employers or relative)

	Name and Occupation	Address	Telephone No.
1)
2)
3)
4)

Record of Education

School	Name and Address of School	Couse of Study	Graduate?
High School			Yes No
College			Yes No
Other			Yes No

Employment History List present and past employment, beginning with your most recent.

Name and Address of Company

Type of Business

Telephone

Describe the work you did

From Mo/Yr	To Mo/Yr	Weekly Starting Salary	Weekly Ending Salary	Reason for Leaving	Name of Supervisor

Name and Address of Company

Type of Business

Telephone

Describe the work you did

From Mo/Yr	To Mo/Yr	Weekly Starting Salary	Weekly Ending Salary	Reason for Leaving	Name of Supervisor

Name and Address of Company

Type of Business

Telephone

Describe the work you did

From Mo/Yr	To Mo/Yr	Weekly Starting Salary	Weekly Ending Salary	Reason for Leaving	Name of Supervisor

Name and Address of Company

Type of Business

Telephone

Describe the work you did

From Mo/Yr	To Mo/Yr	Weekly Starting Salary	Weekly Ending Salary	Reason for Leaving	Name of Supervisor

I hearby give permission to contact the employers listed above concerning my prior work experience as indicted below:

Employer 1	Yes No
Employer 2	Yes No
Employer 3	Yes No
Employer 4	Yes No

May we call you to follow up on this application at home?
Yes No

If yes, what is the best time to call?

May we call you to follow up on this application at work?
Yes No

If yes, what is the best time to call?

What is your business telephone number?

By submitting this application form you agree to and accept the following:
The facts set forth in my application for employment are true and complete. I understand that if employed, any false statement on this application may result in my dismissal. I further understand that this application is not and is not intended to be a contract of employment, nor does this application obligate the employer in any way if the employer decides to employ me. I understand and agree that my employment is at-will and can be terminated by either party with or without notice, at any time, for any reason or no reason. No one other than an officer 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 and then only in a writing signed by an officer.