Employment Application

= All Fields Are Required

Position Applied For
Today's Date
First Name
Last Name
Email Address
Phone Number
Street
City
State/Province
Postal Code
Tell Us A Little Bit About Yourself
Education - List School or Classes Attended
(Note: If you have not graduated, list last completed grade.)
Institution
1.
2.
3.
Degree Received



Date



References - Please Provide Three References
(Note: Do not include family members.)
Name
1.
2.
3.
Phone Number



Relationship



Employment Experience
List the 3 most recent positions that you have held.
Company
Job Title
Pay
Date Started
Date Ended
Reason for Leaving
Brief Job Description

Company
Job Title
Pay
Date Started
Date Ended
Reason for Leaving
Brief Job Description

Company
Job Title
Pay
Date Started
Date Ended
Reason for Leaving
Brief Job Description
Computer Experience
(Include e-mail, web, Microsoft Excel, Microsoft Word, etc.)
Outside Interests
Interests, Hobbies
Civic, Community, Church
(List any organizations that you belong to and offices held.)
Other Information
(List any other information that might qualify you for this position.)
Additional Questions
Have you ever been convicted or charged with a felony, misdemeanor, or other offense other than a minor traffic violation?
Yes No
If yes, please explain further:
Expected Hourly Pay Rate
$/hour
Date Available for Work?
Are you available to work from 8am to 5pm Monday through Saturday and later if need arises?
Yes No
Do you have transportation to work?
Yes No
Essay
In 100 words, please explain why we should hire you over the other candidates. You may include your experience, knowledge personal attributes, or other reasons.
Final Signature
My signature below confirms that:
The information that I have provided is true and correct to the best of my knowledge. I authorize you to confirm any information provided, obtain employment references and personal history, reputation for honesty, ability, and responsibility and obtain a consumer report which may include a criminal background check information.

I release all parties and persons from liability that may result from furnishing such information to you, as well as, from the disclosure of such information to you. Any misrepresentation, falsification, or material omission on this application may result in my failure to receive an offer of work or dismissal from employment if hired.

I agree that the employment relationship may be terminated either by me or by you, with or without notice at any time. I authorize you to give out any information regarding my employment with this company, if hired, and release all parties from liability that may result from furnishing such information.
Name
Today's Date
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