Online Application for Employment

All applications for employment are kept in active status for a period of 30 days. If you wish to have your application remain active for a longer period of time, please notify us in writing.

Name:
	last	first	middle
Address:
	street	city	state	zip

Home Phone:

Work Phone:

What is your resident immigration status?

Type of work or position desired?

Date available for work?

How were you referred to us?

Have you filed an application here before?

Yes No

If yes, give date:

Have you ever been employed here before?

Yes No

If yes, give date:

Are you employed now?

Yes No

May we contact your present employer?

Yes No

Employer:

Dates Employed
From	To

Hourly Rate/Salary
Starting	Final

Address:

City, State, Zip:

Work Performed:

Job Title:

Supervisor:

Reason for Leaving:

Telephone:

Employer:

Dates Employed
From	To

Hourly Rate/Salary
Starting	Final

Address:

City, State, Zip:

Work Performed:

Job Title:

Supervisor:

Reason for Leaving:

Telephone:

Employer:

Dates Employed
From	To

Hourly Rate/Salary
Starting	Final

Address:

City, State, Zip:

Work Performed:

Job Title:

Supervisor:

Reason for Leaving:

Telephone:

Employer:

Dates Employed
From	To

Hourly Rate/Salary
Starting	Final

Address:

City, State, Zip:

Work Performed:

Job Title:

Supervisor:

Reason for Leaving:

Telephone:

Employer:

Dates Employed
From	To

Hourly Rate/Salary
Starting	Final

Address:

City, State, Zip:

Work Performed:

Job Title:

Supervisor:

Reason for Leaving:

Telephone:

What are your present annual salary requirements?

Check any previous training:

Gen Admin or Mgmt	Shorthand wpm	Telex/Facsimilie
Programming	Typing wpm	Switchboard
Computer	Gen Office	Other:
Statistics	Key Punch Operator
Word Processing	Calculator

Education	School Name & Location	Major/Minor	Degree	GPA
High School:
College:
College:
Graduate School:
Technical School:
Other:

Summarize special skills and qualifications acquired from employment or other experience:

List subjects of special study or interest:

Have you served in the Armed Services?

Yes No

Type of discharge?

Reserve status?

Rank, assignments and special training while in service?

Are you available to travel in relation to your work?

Regularly
Occasionally
Never

Have you ever been bonded?

Yes No

If yes, please list the most recent Bonding Company:

Have you ever been convicted of a felony or misdemeanor?

Yes No

If yes, please describe:

Have you ever worked under another name for this company?

Yes No

If yes, please state name:

Indicate languages you speak, read, and/or write:

	Fair	Good	Fluent
Speak
Read
Write

List at least three but not more than four persons who are not related to you in any way who have known you for at least a year.

Name:		Address:		Years Known:
Phone:

Name:		Address:		Years Known:
Phone:

Name:		Address:		Years Known:
Phone:

Name:		Address:		Years Known:
Phone:

To help us evaluate the effectiveness of our efforts to attract employees, please check the following that apply. This will not affect your eligibility for employment.

	I was referred by one of your current employees.
	If so, whom?
	Newspaper Ad
	If so, which paper?
	Radio Ad
	Drove by and just stopped in
	Other:

It is agreed and understood that any misrepresentation of information given by me in completion of this application shall be considered an act of dishonesty which will result in my being denied employment or terminated if I have already been employed.

It is agreed and understood that the Company or its agents may investigate my background to ascertain any and all information of concern relating to my record, whether same is of record or not, and I hereby release the Company and persons named herein from all liability for any damages on account of their furnishing such information.

It is also agreed and understood that under the Fair Credit Report Act, Public Law 91508, I have been told that this investigation may include an investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.

I also agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

It is agreed and understood that this application for employment in no way obligates the Company to employ me, and that if I am hired, I will be required to successfully complete a probationary period of employment, during which I may be discharged without recourse.

I further certify that I have personally completed this employment application and that all of the entries contained within the application, and any information submitted along with the application, are true and complete to the best of my knowledge.