Employment Application

Personal Information

First Name: _____________________________
Middle Name: ___________________________
Last Name: _____________________________

Have you ever applied for employment with us?
Yes: _______ No: _______ If yes, when ?____________________________

Position Desired

Title: _______________________________________
Desired Salary: $_______
If you prefer to work in a different zip code than where you currently live, please indicate where you would like to be located below.
City: ______________________________ State: ______ Zip: ________

Work Eligibility

Are you eligible to work in the United States? Yes: _______ No: _______
Are you available to work holidays? Yes: _______ No: _______

When will you be available to begin work? ______/______ (Month/Year)

Are you 17 or older? Yes: _______ No: _______

Have you been convicted of or pleaded no contest to a felony within the last five years? Yes:_______ No:_______
If yes, please explain: _________________________________________
___________________________________________________________

Have you been convicted of, pleaded guilty to, or pleaded no contest to, an act of dishonesty, or breach of trust or moral turpitude, such as misdemeanor petty theft, burglary, fraud, writing bad checks, and other related crimes within the last five (5) years? * Yes: _______ No: _______
If yes, please explain: _________________________________________
___________________________________________________________

Do you have other special training or skills (additional spoken or written languages, computer software knowledge, machine operation experience, etc.)?
_________________________________________________________
_________________________________________________________

How did you hear of our organization?
___________________________________________________________
___________________________________________________________
___________________________________________________________

*Conviction of a crime, or pleading guilty to a criminal charge, will not necessarily disqualify you from the job for which you are applying. Each conviction or plea will be considered with respect to time, job relatedness, and other relevant factors.

Availability

Days Available
Sun. ____ Mon. ____ Tues. ____ Wed. ____ Th. ____ Fri. ____ Sat. ____
Total Hours Available: _______ Hours Available: from _______ to ______

Education

High School: __________________________________ City:______________ State: _______
College: ______________________________________ City:______________ State: _______
Course of Study: ___________________________________ # of Years Completed:_______
Did You Graduate? Yes: _______ No: _______ Degree: _________________________

Employment History

Please give accurate and complete full-time employment record. Start with present or most recent employer. Include military experience if applicable.

Position #1
Company Name: _________________________ City:_____________________ State: _______
Company Phone Number: ________________________
Job Title: _____________________________________
Name of Supervisor: ____________________________
Employed (Month and Year) From: _______ To: _______
Weekly Pay:_______
Describe your work: __________________________________________
__________________________________________________________

May we contact this employer? Yes: _______ No: _______
If not, why not? _______________________________________________
Reason for leaving: ____________________________________________

Position #2
Company Name: _________________________ City:_____________________ State: _______
Company Phone Number: ________________________
Job Title: _____________________________________
Name of Supervisor: ____________________________
Employed (Month and Year) From: _______ To: _______
Weekly Pay:_______
Describe your work: __________________________________________
__________________________________________________________

May we contact this employer? Yes: _______ No: _______
If not, why not? _______________________________________________
Reason for leaving: ____________________________________________

Is there anything else you would like us to know about you?