Emplopyment Opportunities
PERSONAL
 
Full Name:

Last

First

Middle
 
Present Address:

Number & Street

City

State

Zip Code
 
Home Phone:
Alternate Phone:
 
How long have you lived here?
 
Previous Address:

Number & Street

City

State

Zip Code
 
How long did you live there?
 
Are you 18 or older? Yes No
If not how old?
 
Have you been convicted of a felony? Yes No
(Conviction does not automatically exclude you from employment consideration)
 
If yes, please explain
 
JOB INTEREST
 
What position you desire?
Hourly rate $ required
 
What date will you be available for employment?
 
Are you looking for full time, temporary, part time, or summer?
 
If part time, what days & hours can you work?
 
Will you work weekends? Yes No
Will you work nights? Yes No
 
Do you have transportation? Yes No
If no, please explain.
 
If employed by us, would you be employed with any other organization, or self-employed? Yes No
 
If yes, please explain.
 
May we contact your present employer for reference? Yes No
Phone #
 
EMPLOYMENT HISTORY
 
List your employment below, beginning with the present or last place worked.
 

1. Company Name

From

To

Duties Performed

Reason for leaving

Supervisor
 
Address
Phone #
 
 

2. Company Name

From

To

Duties Performed

Reason for leaving

Supervisor
 
Address
Phone #
 
 

3. Company Name

From

To

Duties Performed

Reason for leaving

Supervisor
 
Address
Phone #
 
 
 

In connection with my application for employment (including contract for services) with you, I understand the investigative background inquiries are to be made on myself including consumer, criminal, driving and other reports. These reports will include information as to my character, work habits, performance and experience along with reasons for termination of past employment from previous employers. Further, I understand that you will be requesting information from previous employers. Furthermore I understand that you will be requesting information from various federal, state and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil and other experiences as well as claims involving me in the files of insurance companies. I also understand that as part of the Company's procedure for processing my employment application, an investigation may be made whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of additional information concerning the nature and scope investigation. If hired I understand that I can leave at anytime or can be terminated at any time. I also understand my continued employment may be subject to the issuance and continued maintenance of a bond by the bonding agent of the Company. I will abide by all Company policies and procedures and will comply with all safety requirements and wear or use protective clothing or devices required by federal or state law and the Company. If requested, I will take a pre-employment physical examination from a physical designated and paid for by the Company. I agree that if the Company finds I have made any intentional omissions or misrepresentations on this application, it may eliminate me from further consideration or withdraw any offer of employment or terminate my employment with any obligation on its part, except for payment to me for services already rendered.

Authorization
Without reservation, I authorize any part or agency contacted by this employer to furnish the above mentioned information.