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Office Job Application
Some fields are required before this form can be submitted, please complete the required fields listed below.
Acknowledgement
Knowing these physical requirements for the job, as listed above, do you forsee any reason that you would not be able to meet these requirements on a daily basis?*
Yes
No
If yes, please explain
Can you work overtime on a short notice basis?*
Yes
No
Application for Employment
Prospective employees will receive consideration without discrimination based on race, creed, color, sex, age, national origin, handicap, veteran status or any condition prescribed by state or local law.
Personal
Last Name*
First Name*
Middle Name*
Date*
Street Address*
City, State, Zip*
Home Telephone*
Business Telephone
Have you ever applied for employment with us?*
Yes
No
If yes, list Month, Year and Location
Postion Desired*
Pay Expected*
Will you work overtime if asked?*
Yes
No
Apart from absence for religious observance, are you available for full-time work?*
Yes
No
If not, what hours can you work?*
Are you legally eligible for employment in the United States?*
Yes
No
When will you be available to begin work?*
Have you been convicted of any crimes in the past ten years, excluding misdemeanors and summary offenses, which have not been annulled, expunged or sealed by a court?*
Yes
No
If yes, describe in full
Have you ever been bonded?*
Yes
No
If yes, with what employers?
Other special training or skills (launguages, machine operation, etc.)
Education
Graduate School
Name and Location of School
Course of Study
Number of years completed
Did you graduate?
Yes
No
Degree or Diploma
College
Name and Location of School
Course of Study
Number of years completed
Did you graduate?
Yes
No
Degree or Diploma
Business Trade Technical
Name and Location of School
Course of Study
Number of years completed
Did you graduate?
Yes
No
Degree or Diploma
High School
Name and location of school
Course of study
Number of years completed
Did you graduate?
Yes
No
Degree or Diploma
Elementary
Name and location of school
Course of study
Number of years completed
Did you graduate?
Yes
No
Degree or Diploma
Employment
Please give accurate, complete full-time and part-time employment record. Start with your present or most recent employer.
Employer 1
Company Name
Address
Name of Supervisor
Telephone
Employed From - To (State Month and Year)
Weekly Pay (Start and Last)
State Job Title and Describe Your Work
Reason for Leaving
Employer 2
Company Name
Address
Name of Supervisor
Telephone
Employed From - To (State month and year)
Weekly Pay (Start and Last)
State Job Title and Describe Your Work
Reason for Leaving
Employer 3
Company Name
Address
Name of Supervisor
Telephone
Employed From - To (State Month and Year)
Weekly Pay (Start and Last)
State Job Title and Describe Your Work
Reason for Leaving
Employer 4
Company Name
Address
Name of Supervisor
Telephone
Employed From - To (State Month and Year)
Weekly Pay (Start and Last)
State Job Title and Describe Your Work
Reason for Leaving
We may contact the employers listed above unless you indicate those you do not want us to contact.
Do Not Contact:
Employer(s) Number
Reason not to contact
Military
Did you serve in the U.S. Armed Forces?*
Yes
No
If yes, what Branch?
Describe any training received relevant to the position for which you are applying.
Additional Information
Membership in professional and civic organizations, special accomplishments, awards, etc. (Exclude those which may disclose your race, color, religion, age or national origin).
Applicant Signature
Please read and understand this statement before signing your application.
The information I have provided in this Application for Employment is true, correct and complete. False, incomplete or misrepresented information of any kind, will be sufficient cause for my application to be rejected or, if discovered after I am employed, cause for immediate termination of my employment.
I authorize the employer to contact and obtain information about me from previous employers, educational institutions and references I provided, and any other party necessary to verify the accuracy of information I disclosed in this application, a related employment resume or a personal interview. To assist in the processing of my Application, I waive all rights and claims I may otherwise have against the employer or its representatives, for seeking and using information to evaluate my employment request and all other persons, corporations or organizations who provide information for this purpose.
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 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 authority to enter into any 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 condition in the above statement.
Full Name
Date
SUBMIT
