| Social Security Number: |
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Phone Number: |
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PRESENT ADDRESS: |
| Street: |
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City: |
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| State: |
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Zip Code: |
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PERMANENT ADDRESS: (Leave blank if same as current) |
| Street: |
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City: |
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| State: |
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Zip Code: |
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| Are You 18 Years or Older? |
Yes
/ No
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| Are you prevented from lawfully becoming employed in this country because of VISA or immigration status? |
Yes
/ No
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EMPLOYMENT DESIRED:
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| Position Desired: |
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Pay (per hour) Desired: |
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| Are You Employed Now? |
Yes
/ No
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If So, May We Contact Your Present Employer? |
Yes
/ No
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| If you were referred by a current employee, you may enter his/her name here: |
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| List your availability here. Include days of the week and the hours you are able to work: |
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| EDUCATION: |
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Name and Location of School |
Number of Years Attended |
Did You Graduate? |
| Grammar School: |
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Yes
/ No
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| High School: |
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Yes
/ No
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| College: |
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Yes
/ No
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| Trade, Business or Correspondence School: |
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Yes
/ No
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GENERAL:
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| Subjects of Special Study or Research Work: |
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Special Skills: |
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| Activities (Civic, Athletic, etc.): |
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U.S. Military or Naval Service: |
Yes
/ No
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| Present Membership in National Guard or Reserves: |
Yes
/ No
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Current Rank (if applicable): |
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PAST EMPLOYMENT:
List below your last three employers, starting with the most recent one first. |
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| Which of these jobs did you like BEST? |
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What did you like most about this job? |
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?I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.
In consideration of my employment, I agree to conform to the company?s rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company?s option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it?s president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.?
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| Do you understand and agree to the above statement? |
Yes
/ No
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| Please Enter the Current Date: |
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| Please Type Your Full Name (First Middle Last) in Place of a Signature: |
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