| We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of non-job-related medical condition or handicap, or any other legally protected status. |
|
|
|
|
|
|
|
| Position(s) applied for: |
|
|
|
|
|
|
|
|
| How did you learn about us? |
Advertisement00Employment Agency00Friend00Relative00Internet search00
Other:
|
|
First Name:
|
Middle Name:
|
Last Name:
|
Address:
|
City:
|
State / province:
|
Zip:
|
Country:
|
Telephone number(s):
|
Social Security Number:
|
E-mail address:
|
|
|
| If employed and you are under 18 can you furnish a work permit?00Yes000No0 |
| Date you would be available for work: |
| Are you available to work:0Full time00Part time00Shift work00Temporary0 |
Have you been convicted of a felony within the last 7 years?0No00Yes0
(Conviction will not necessarily disqualify applicant from employment.) |
|
|
|
|
|
|
|
| Education |
| Elementary school: |
School name and location:
|
Years completed:
Diploma/Degree:
|
|
| High school: |
School name and location:
|
Years completed:
Diploma/Degree:
|
|
| College / University: |
School name and location:
|
Years completed:
Diploma/Degree:
|
Describe course of study:
|
|
| Graduate / Professional: |
School name and location:
|
Years completed:
Diploma/Degree:
|
Describe course of study:
|
|
|
Describe specialized training, apprenticeship, skills, and extra-curricular activities:
|
|
|
|
|
|
|
|
| Employment experience |
| Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status. |
|
|
|
Employer:
|
Telephone number(s):
|
Address:
|
Supervisor:
|
Job title:
|
Dates employed:
|
Hourly rate / salary:
|
Reason for leaving:
|
Work performed:
|
|
|
Employer:
|
Telephone number(s):
|
Address:
|
Supervisor:
|
Job title:
|
Dates employed:
|
Hourly rate / salary:
|
Reason for leaving:
|
Work performed:
|
|
|
Employer:
|
Telephone number(s):
|
Address:
|
Supervisor:
|
Job title:
|
Dates employed:
|
Hourly rate / salary:
|
Reason for leaving:
|
Work performed:
|
|
|
|
|
|
|
|
| Special skills and qualifications |
| Summarize special job-related skills and qualifications acquired from employment or other experience. |
|
|
|
|
|
|
|
|
| Applicant's statement |
| I certify that answers given herein are true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. |
|
Please check if you agree with the above statement0 Date:
|
|
|
|
|