law prohibits discrimination on the basis of race, color, religion, sex,
national origin, age, disability, or other protected status.
Social Secutiry No:
Drivers License No.:
State liscense issued in:
How did you hear about this position?
Can you prove you are legally
eligible to work in the U.S.?
If under 18 years of age, can you furnish a work permit if required?
If not, please explain:
If hired, are you able to get to work and meet attendance requirements
Have you been convicted of a felony in the last five years?
If so, please explain:
(Conviction does not automatically bar you from employment
Type of employment wanted:
Date available to work:
What hours do you prefer to work?
Can you work overtime, if required?
Weekends if required?
Please list hours you cannot work?
Will you relocate if the job requires it?
Will you travel if required?
How many days of work or school have you missed in the last year for reasons
other than sickness?
many days have you been late in the last year?
Highest level of education attained:
What field if Trade/Technical School
What division if Military:
If college, college name:
Grade Point Average:
Are you currently in school?
Summarize any special training or skills that
may qualify you for the position you are applying for:
(Please list your last four employees, starting with
the most recent)
explain any employment gaps found above:
May we contact the employees listed above?
If there are any you do not wish us to contact,
please indicate them.
that the statements contained herein are true and correct to the best
of my knowledge, and I understand that any false statements or omissions
by me on this application and any other required document is considered
a cause for denial of employment or discharge, whenever discovered.
I undestand that this document is an application for
employment, and does notg constitute an agreement or contract for employment
of any length of time. If hired, I have freedom to quit at any time.
The employer also has the right to terminate my employment with or without
cause, the exceptions being as required by law.
I authorize the above employer to investigate all information
in the above application for employment. The employer has the right
to contact previous employers, schools, and other references to verify
this imformation. I release the employer from any liability in gathering
this information. I release from liability any companies or institutions
supplying this information. After termination of my employment, for
whatever reason, I release the above employer from liability for any
information supplied to future potential employers.