Employment Application

Application for Employment

Our company is an equal opportunity employer and will consider all applicants for all positions equally without regard to their race, sex, age, color, religion, national origin, veteran status or any disability as provided in the Americans With Disabilities Act.
This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered.

Personal

Position(s) Applied for:

How did you learn of our company and/or position?

	Advertisement		Friend		Walk-In
	Employment Agency		Relative		Other

Last Name

First Name

Middle

Address

City

State

Zip

Telephone Number

Social Security Number

Drivers License #

State Issued

Expiration Date

Have you ever applied to our company before?	Yes			No

Have you ever worked for our company before?	Yes			No

Are you over 18 years of age?	Yes			No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?	Yes			No

On what date would you be able for work?

Are you seeking:	Full-time	Part-Time		On-Call	Temporary work

Are you now, or do you expect to be working in any other business or job?	Yes			No

Are there any days or hours you would be unable or unwilling to work?	Yes			No

If yes please specify:

If you worked in any of your previous positions under another name, please give that name(s) below: (for reference checking purposes)	Name			Company
	Name			Company

Are you presently employed?	Yes			No

May we contact your present employer?	Yes			No

Have you ever been fired, or asked to resign from a job?	Yes			No
If yes please explain:

Have you ever been disciplined or received verbal or written warnings or absenteeism or tardiness?	Yes			No
If yes please explain:

Have you ever served in the military?	Yes No
Service Branch Date Entered
Final Rank Separated

Have you ever been convicted of any crime?				Yes	No
If yes, state the offense, location, date, and disposition:

Note: A conviction will not necessarily disqualify you from employment.

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

Do you have the ability with or without reasonable accommodations, to perform the activities required by the position for which you are applying?			Yes No

Education

	Name & Address of School	Course of Study	Dates	Diploma Degree
Elementary
High School
Undergraduate
Graduate Professional
Other(Specify)

Are you planning to pursue further studies? If so, when and what courses?

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

Indicate any foreign languages you can speak, read, and/or write.
	FLUENT	GOOD	FAIR
SPEAK
READ
WRITE

Specialized Skills

CRT	FAX	Word Perfect	Microsoft Excel
PC	Typewriter	Microsoft Word	Internet
Calculator	PBX System	Microsoft Access	Microsoft PowerPoint

Employment Experience

Employer		Dates Employed		Work Performed
Address		To	From
Telephone Numbers
Job Title	Supervisor	Hourly Rate/Salary
Reason for Leaving		Starting	Final

Employer		Dates Employed		Work Performed
Address		To	From
Telephone Numbers
Job Title	Supervisor	Hourly Rate/Salary
Reason for Leaving		Starting	Final

Employer		Dates Employed		Work Performed
Address		To	From
Telephone Numbers
Job Title	Supervisor	Hourly Rate/Salary
Reason for Leaving		Starting	Final

Driving Record

Please complete the following questions regarding your driving record. If you answer yes to any of the questions, please provide an explanation.

Have you been in any accidents where you were found at fault?		If Yes explain below

Have you ever been issued a traffic citation?		If Yes explain below (if more than one, please explain each)

Do you presently have any points against you driving record?		If Yes, how many points

Has your license ever been suspended/revoked?		If Yes explain circumstances surrounding suspension

If you license was suspended/revoked, has it since been reinstated?

Have you ever been convicted of a DUI (driving under the influence)?		If Yes, please explain

Have you ever been denied auto insurance due to your driving record?		If Yes, please explain

Do you presently have auto insurance as required by state law?		If No, please explain

Please print the Application after completion and Fax it to us at (305) 665-1418

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