Employment Application Form

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APPLICANT INFORMATION

Last Name

First Name

Date

Street Address

Apartment/Unit #

City

State

Zip

Phone

Email Address

Date Available

Desired Salary

Position Applied for

Are you authorized to work in the U.S.?

YesNo

Have you ever worked for this company?

YesNo

If so, when?

Have you ever plead guilty or no contest to, or been convicted of a crime?

YesNo

If yes, explain

EDUCATION

High School

Address

Number of years

Did you graduate?

YesNo

Course of Study

College

Address

Did you graduate?

YesNo

Course of Study

Other

Address

Did you graduate?

YesNo

Degree

Skills & Qualifications: Summarize any training, skills, licenses and/or certificates that may qualify you as being able to perform in the position for which you are applying:

PREVIOUS EMPLOYMENT- LIST CURRENT OR MOST RECENT FIRST

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Summarize Job Responsibilities

Employment Duration (From - To)

Reason for Leaving

May we contact your previous supervisor for a reference?

YesNo

DISCLAIMER AND SIGNATURE
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

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

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

I certify that my answers are true and complete to the best of my knowledge and I have read, fully understand and accept all terms of the foregoing applicant statement.