Federal Law > Handbooks - Policies > Application for Employment

Application for Employment

 
(Company)

SAMPLE APPLICATION FOR EMPLOYMENT

We consider qualified applicants for all positions without regard to race, color, religion, sex, national origin, age, veteran status, handicap, or any other legally protected status.

________________________________________________________________________

PLEASE PRINT

Date___________

A. PERSONAL INFORMATION

Name _________________________ Social Security No.

Street Address

City _________________ State ___________________ Zip Code

Business Telephone:__________________ Home Telephone:

Are you 18 years of age or older? Yes______ No______

Are you prevented from becoming lawfully employed because of visa or immigration status? Yes______ No______

In case of emergency contact:

Name____________________________________________

Address _________________________________ Phone Number


B. EMPLOYMENT DESIRED

Position: _________________________ Date you can start: ________

Salary Desired: ___________________

Are you able to perform the essential functions of the position for which you have applied, with or without reasonable accomodation? Yes______ No______

Have you applied to this company before? ____________

Where?______________________________

When? ______________________________

Have you been previously employed by this company? _________

Where? ______________________________

When? ______________________________

Reason for leaving

Who referred you to this company?

C. EDUCATION
  Name and Location No. of Years Attended Subjects Studied Did You Graduate?
High School        
College        
Other        


C. MILITARY EXPERIENCE

Were you in the military service? Yes______ No______

If yes, what branch and rank at separation?

Briefly describe your duties

D. EMPLOYMENT HISTORY

State the following: (identify your last five employers, starting with the latest one).

Date/Month and Year Name / Address of Employer Name / Address of Supervisor Position Reason for Leaving
From:

To:
       
From:

To:
       
From:

To:
       
From:

To:
       



E. REFERENCES (give the names of three persons you have known at least one year and who are not related to you.)

Name

Address

Business

Years Acquainted

1.________________ ________________________ ____________ _________________
2.________________ ________________________ ____________ _________________
3.________________ ________________________ ____________ _________________


CERTIFICATE OF APPLICANT (READ CAREFULLY BEFORE SIGNING)

I certify that the information in this application (and accompanying resume or information) is true. I also agree and understand that misrepresentations or false or omitted facts may disqualify me from further consideration for employment and may be considered justification for my termination if discovered at a later date.

I authorize investigation of the statements contained herein and the references listed above to give you any and all information such persons, schools, and employers or organizations may have, and release all parties from all liability for any damage that may result from furnishing this information to you. I authorize you to request and receive any and all information from my entire work and personal history.

I understand that, if hired, my employment is for no definite period and may be terminated at any time, with or without cause, at the discretion of either the company or myself. I understand that I will remain an at will employee and can be terminated at any time without any notice, absent a written contract signed by the President of the Company and myself. If I am employed, it is also understood that the Company, at its sole option and without prior notice, can change wages, benefits, rules, regulations and the conditions of my employment at any time.

I acknowledge that I may be offered employment subject to a medical examination and/or questionnaire, and that such examination and/or questionnaire could nullify my ultimate employment by this employer. I agree to submit to any such medical examination and/or questionnaire.

Signature of Applicant________________________________ Date___________________
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