Employment Application

We consider applications for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, sexual orientation, citizenship status, genetic information or any other legally protected status.

Position(s) Applied For:

How Did You Learn About Us?

Advertisement Employment Agency Relative Friend Inquiry Other:

Last Name:

First Name:

Middle Name:

Street Address:

City:

State:

Zip:

Telephone:

Best time to contact you at home is:

If you are under 18 years of age, can you provide required proof of your eligibility to work?	Yes No
Have you ever filed an application with us before?	Yes No	If Yes, give date:

Have you ever been employed with us before?

Yes No

If Yes, give date:

Do any of your friends or relatives, other than spouse, work here?

Yes No

Are you currently employed?

Yes No

May we contact your present employer?

Yes No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment.

Yes No

Date available for work:

What is your desired salary range?

Are you available to work:	Full-Time	Please indicate:	1st Shift	2nd Shift	3rd Shift
	Part-Time	Please indicate:	Mornings	Afternoon	Evenings
	Temporary	Please indicate dates available:		until

Are you currently on "lay-off" status and subject to recall?

Yes No

Can you travel if a job requires it?

Yes No

Education

High School
Name:
Address:
Course of Study:	Number of Years Completed:	Diploma Degree:

Undergraduate College
Name:
Address:
Course of Study:	Number of Years Completed:	Diploma Degree:

Graduate Professional
Name:
Address:
Course of Study:	Number of Years Completed:	Diploma Degree:

Other (Specify)
Name:
Address:
Course of Study:	Number of Years Completed:	Diploma Degree:

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Describe any job-related training received in the United States military.

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

1.	Employer:	Dates Employed		Work Performed
	Address:	From	To
	Telephone Number(s):
	Job Title:
	Supervisor:
	Reason for Leaving:

2.	Employer:	Dates Employed		Work Performed
	Address:	From	To
	Telephone Number(s):
	Job Title:
	Supervisor:
	Reason for Leaving:

3.	Employer:	Dates Employed		Work Performed
	Address:	From	To
	Telephone Number(s):
	Job Title:
	Supervisor:
	Reason for Leaving:

4.	Employer:	Dates Employed		Work Performed
	Address:	From	To
	Telephone Number(s):
	Job Title:
	Supervisor:
	Reason for Leaving:

List professional, trade, business or civic activities and offices held.
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status:

Additional Information

Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.

Specialized Skills (Check Skills/Equipment Operated)
Terminal	Spreadsheet	Production/Mobile Machinery (list)	Other (list)
PC/MAC	Word Processing
Typewriter	Shorthand
	WPM

State any additional information you feel may be helpful to us in considering your application.

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation?

Yes No

References

1.	Name:	Telephone:
	Address:
2.	Name:	Telephone:
	Address:
3.	Name:	Telephone:
	Address:

Applicant's Statement

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Full Name:

Email: