APPLICATION FOR EMPLOYMENT Instructions: We appreciate your interest in our organization. We consider applicants for all positions without regard to race, color, creed, age, religion, sex, sexual orientation, disability, marital status, genetic predisposition or carrier status, national origin, U.S. military service or arrest/conviction record. PERSONAL INFORMATION DATE: NAME STREET ADDRESS CITY STATE ZIP CODE SOCIAL SECURITY NUMBER PHONE NUMBER ANY OTHER NAME(S) UNDER WHICH YOU HAVE BEEN PREVIOUSLY EMPLOYED OR UNDER WHICH SCHOOL RECORDS WOULD BE LOCATED. NAMES OF FRIENDS OR RELATIVES EMPLOYED IN THIS ORGANIZATION If you are under 18 years of age, can you furnish a work permit? YES NO Have you ever been employed with us before? YES NO If yes, give dates. Are you a citizen of the U.S. or do you have a valid work permit? YES NO Can you work overtime, if required? YES NO Can you work consistently and report to work on time? YES NO Have you ever been convicted of a crime? (Conviction will not necessarily disqualify an applicant) YES NO If Yes, please list dates of offenses and dispositions. Have you ever had any training in the military related to the job you're applying for? YES NO If Yes, please describe: EMPLOYMENT DESIRED Position: Date Available: Are you available to work: Full Time Part Time Shiftwork Temporary Can you travel if the job requires it? YES NO Are there any travel limitations? YES NO What are they? EDUCATION Name of School Address # Years Degree Elementary School High School College Trade, Business or Correspondence School Professional organizations and/or licenses that you may be job related: References: Give name, address and a telephone number of three references who are qualified to evaluate your capabilities and who are not related to you and are not previous employers. 1. 2. 3. EMPLOYMENT EXPERIENCE - List below your last five employers beginning with present or most recent. Month/Year Name and Address of Employer Rate of Pay Position Reason for Leaving From Phone # To Supervisor May we contact employer? YES NO From Phone # To Supervisor May we contact employer? YES NO From Phone # To Supervisor May we contact employer? YES NO From Phone # To Supervisor May we contact employer? YES NO From Phone # To Supervisor May we contact employer? YES NO APPLICANT'S STATEMENT I certify that answers given herein are true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in withdrawal of an offer of employment, or if subsequent to employment, may result in dismissal. I understand this employment application is not to be construed as a guarantee of employment. I further understand that, should I become employed, my employment with the organization does not constitute any form of contract, implied or expressed, and such employment may be terminated at will either by myself or my employer upon notice of one party to the other. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. You may use this authority to check references with former employers I have listed, unless otherwise indicated, as well as the personal references listed. Signature of Applicant (By entering your name, you certify the above statement) Date APPBS 12/05 ©National Employers Council, Inc.
APPLICATION FOR EMPLOYMENT Instructions: We appreciate your interest in our organization. We consider applicants for all positions without regard to race, color, creed, age, religion, sex, sexual orientation, disability, marital status, genetic predisposition or carrier status, national origin, U.S. military service or arrest/conviction record. PERSONAL INFORMATION DATE:
NAME
STREET ADDRESS CITY STATE ZIP CODE SOCIAL SECURITY NUMBER PHONE NUMBER ANY OTHER NAME(S) UNDER WHICH YOU HAVE BEEN PREVIOUSLY EMPLOYED OR UNDER WHICH SCHOOL RECORDS WOULD BE LOCATED. NAMES OF FRIENDS OR RELATIVES EMPLOYED IN THIS ORGANIZATION If you are under 18 years of age, can you furnish a work permit? YES NO Have you ever been employed with us before? YES NO If yes, give dates.
Are you a citizen of the U.S. or do you have a valid work permit? YES NO Can you work overtime, if required? YES NO Can you work consistently and report to work on time? YES NO Have you ever been convicted of a crime? (Conviction will not necessarily disqualify an applicant) YES NO If Yes, please list dates of offenses and dispositions. Have you ever had any training in the military related to the job you're applying for? YES NO If Yes, please describe:
EMPLOYMENT DESIRED Position: Date Available: Are you available to work: Full Time Part Time Shiftwork Temporary Can you travel if the job requires it? YES NO Are there any travel limitations? YES NO What are they? EDUCATION
Professional organizations and/or licenses that you may be job related: References: Give name, address and a telephone number of three references who are qualified to evaluate your capabilities and who are not related to you and are not previous employers. 1. 2. 3.
EMPLOYMENT EXPERIENCE - List below your last five employers beginning with present or most recent.
May we contact employer? YES NO
APPLICANT'S STATEMENT I certify that answers given herein are true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in withdrawal of an offer of employment, or if subsequent to employment, may result in dismissal. I understand this employment application is not to be construed as a guarantee of employment. I further understand that, should I become employed, my employment with the organization does not constitute any form of contract, implied or expressed, and such employment may be terminated at will either by myself or my employer upon notice of one party to the other. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. You may use this authority to check references with former employers I have listed, unless otherwise indicated, as well as the personal references listed.
Signature of Applicant (By entering your name, you certify the above statement)
Date
APPBS 12/05 ©National Employers Council, Inc.