Employment Application

We consider applicants for all positions without regards to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job related medical condition or handicap, or any other legally protected status.
Please fill out the employment application below.

Personal Information

Last Name First Name Middle Initial
Street City State Zip
Home Telephone Business Telephone
Have you ever applied for employment with us?
Yes No If yes, when?
Position Desired Pay Expected Special Skills Will you work overtime if asked?
Yes No When will you be available to begin work?
If you are under 18 years of age, can you provide required proof of your eligibility to work?
Yes No Do you have a current drivers license?
Yes No Have you ever been employed with us before?
Yes No If yes, when?
Are you currently employed?
Yes No May we contact your present employer?
Yes No 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.
Yes No Are you available to work:
Full Time Part Time Shift Work Temporary Are you currently on "lay-off" status and subject to recall?
Yes No Can you travel if a job requires it?
Yes No Have you been convicted of a felony within the last 7 years?
Yes No If yes, please explain:
Are you a high school graduate?
Yes No If so, High School and Graduation Date:
Have you had any job-related training in the U.S. Military?
Yes No Have you ever been injured on the job?
Yes No If so, How?

EMPLOYMENT EXPERIENCE

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap, or other protected status.

Employer Start Date End Date
Address Telephone Number
Job Title Work Performed
Start Hourly/Salary Final Hourly/Salary
Reason For Leaving

Employer Start Date End Date
Address Telephone Number
Job Title Work Performed
Start Hourly/Salary Final Hourly/Salary
Reason For Leaving

Applicant's Statement

I certify that the answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as 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 on 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 specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that the 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.

I have read and accept the above Applicant's Statement
Date

Additional Information

We keep the following information on file since it is required to obtain passes from Government Installations. It is not used in determining hiring eligibility.

Date of Birth Eye Color Hair Color
Height Weight