Employment Application PDF

APPLICATION
FOR
EMPLOYMENT
®
We at are committed to a policy of equal treatment and opportunity in
every aspect of our employment relations without regard to race, color, religion, sex,
national origin, age, disability, genetic information or other legally protected class status.
This includes, but is not limited to, recruiting, hiring selection for training, transfers,
promotions, compensation, and any company sponsored social and recreational
programs.
1
Employment Application
Applicant Information
Text
Name: ____________________________________________________________________________________ Date: _______________________
Address:_______________________________________________________________________________________________________________
Email: _________________________________ Social Security Number (optional): _____________________ Phone: _____________________
Referred by: Advertisement Agency Person Other:_________________________________________________________
Are you legally eligible for employment in the U.S.A? YES NO State age if under 18:_______________________________
Position Applied for: ___________________________________________________ Salary Expected:____________________________________
Are you available to work Full-time Part-time Seasonal Date available for work: ______________________________
Shift Availability: Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Specify schedule limitations _______________________________________________________________________________________________
Were you previously employed by us? YES NO If yes, when?________List friends or relatives in our employ: _______________________
Other name(s) used while attending schools or places of employment indicated on this form: ____________________________________________
Military Service? YES NO
Branch and Rank: _______________________________________________________________________________________________________
Dates of Service: ________________________________________________________________________________________________________
Can you perform the primary functions of this job with or without reasonable accommodations? YES NO
Education
High School: _______________________________________________ Vocational: ________________________________________________

Scholastic Average: __________________________________________ Course of Study: ____________________________________________
Graduated? YES NO Scholastic Average: __________________________________________
Graduated? YES NO
Degree: ___________________________________________________
College: ___________________________________________________ Additional Education: ________________________________________

Course of Study: ____________________________________________ Course of Study: ____________________________________________
Scholastic Average: __________________________________________ Scholastic Average: __________________________________________
Graduated? YES NO Graduated? YES NO
Degree: ___________________________________________________ Degree: ___________________________________________________
Additional Comments Regarding Education:
2
Skills
List computers systems and software in which you are proficient: __________________________________________________________________
Describe any point of sale system experience: _________________________________________________________________________________
Please list languages that you can speak fluently: _______________________________________________________________________________
Please list languages that you can write fluently: _______________________________________________________________________________
Please list languages that you can read fluently: ________________________________________________________________________________
Additional Qualifications
Please use the space provided below to summarize any additional information necessary to fully describe your qualifications.
Employment History
(List present or most recent employer first)
Company: __________________________________________ Address: ___________________________________________________________

Supervisor:_______________________________________ Salary: _______________________ Phone: _________________________________
Job Title: __________________________________________________________ Date Started: _____________ Date Left: __________________
Job Description: Reason for Leaving:
Company: _________________________________________ Address: ____________________________________________________________

Company: _________________________________________ Address: ____________________________________________________________

Please indicate previous employers you do not wish contacted: ____________________________________________________________________
3
References
Please list three persons other than relatives or personal friends, who can judge your work ability.
Name: _________________________________________________ Occupation: ___________________________________________________
Relationship: __________________________________________________________________ Phone: ________________________________
Name: _________________________________________________ Occupation: ___________________________________________________

Name: _________________________________________________ Occupation: ___________________________________________________

Applicant Authorization For Background Check

I authorize to verify employment, as well as conduct criminal and vehicular record check. Signature:
_________________________________________________________________________________ Date: ______________________
Applicant Certification and Agreement

All information written on this application is complete and accurate to the best of my knowledge. I understand that any misrepresentation of facts
in this application disqualifies me from further consideration - or if employed - is grounds for dismissal. I understand that any employment
offer is contingent upon satisfactory references and I authorize to investigate past employment and education history, as
well as references given on application.
I understand that if employed such employment may be terminated for just cause, or no cause, by or myself at any time 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 an Officer, and then only when in writing and signed by the
Officer, 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.
I fully understand and agree to all statements above.
Signature:__________________________________________________________________________________ Date_______________________

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APPLICATION

High School: _ Vocational: __

College: ___________ Additional Education:

Additional Comments Regarding Education:

Company: Address: _________________

Job Description: Reason for Leaving:

Company: _ Address: ____________________

Job Description: Reason for Leaving:

Company: _ Address: ____________________

Job Description: Reason for Leaving:

Please indicate previous employers you do not wish contacted: ____________________________________________________________________

Name: _ Occupation: ___

Name: _ Occupation: ___

Applicant Authorization For Background Check

___________________________________________________________ Date:

Applicant Certification and Agreement

I fully understand and agree to all statements above.

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