Application

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, disability, marital of veteran status, or any other legally protected status.

Position(s) Applied For:  Date of Application:  How did you learn about us?: 
       
First Name:  Middle Name:  Last Name: 

 
 
 

Address Number:  Street Address:  City: 
     
State/Province:  Zip   
     
Phone:  Email:   

 
 		  
     
Best time to contact you at home
 
If you are under 18 years of age, can you provide required proof of your eligibility to work?

Have you ever filed an application to work with us before? 

If yes, give date:  

Have you ever been employed with us before?

If yes, give date:

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

If yes, state name relationship and location: 

Are you currently employed?

May we contact your present employer?

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.
Date available for work

What is your desired salary range?  

Are you available to work (multiple selection available). . . 

If Temporary, please indicate dates of availability 

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

Can you travel if a job requires it?

Education
School  Name and Address of School  Course of Study  Years Completed  Diploma/Degree 
High School 
Undergraduate 
Graduate
Professional 
Other (Specify) 
Work Experience
Start with your present or last job. Include any job-related military service assignments or volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disability, or other protected status
Employer 1 Dates Employed    Starting/Present Job Title 
  From:  To:   
Address      Work Performed 
       
Telephone Numbers  Hourly Rate / Salary     
  Starting:  Final:   
Supervisor       
  May We Contact?    Reason for Leaving 
       

Employer 2 Dates Employed    Starting/Present Job Title 
  From:  To:   
Address      Work Performed 
       
Telephone Numbers  Hourly Rate / Salary      
  Starting:  Final:   
Supervisor       
  May We Contact?     Reason for Leaving 
       

Employer 3 Dates Employed     Starting/Present Job Title 
  From:  To:   
Address      Work Performed 
       
Telephone Numbers  Hourly Rate / Salary      
  Starting:  Final   
Supervisor       
May We Contact?     Reason for Leaving 
       

Employer 4 Dates Employed     Starting/Present Job Title 
  From:   To:   
Address      Work Performed 
       
Telephone Numbers  Hourly Rate / Salary      
  Starting:  Final:   
Supervisor       
  May We Contact?     Reason for Leaving 
       
Comments: Include any explanation of any gaps in employment.

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

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

List professional, trade, business or civic activites and offices held.

You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disablity or other protected status.
Additional Information
Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience

Specialized Skills Skills / Equipment Operated
    Terminal        Spreadsheet   
    PC/Mac        Word Processing   
    Typewriter         Shorthand  
      WPM        WPM 
               

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


Personal / Professional References Do not include family members or past supervisors
Name  Phone  Best Time to Call  Occupation 
       
       
       

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without a reasonable accomodation, the activities involved in the job or occupation for which you have applied?
A review of the activites involved in such a job or occupation has been given

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 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. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specificallyacknowledge in writing by an authorized executive of this organization.

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.

By entering my name and the current date in the fields below I am electronically signing this application.

Attachment(s) to this Application:

By entering my name and the current date in the fields below I am electronically signing this application.

Applicant's Name:   
Date: