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EMPLOYMENT APPLICATION
*Required Field
All Open Fields Are Expandable
Morning:
8:00am - 12:00pm
Afternoon:
12:00pm - 6:00pm
Evening:
6:00pm - 9:00pm
Anytime:
Yes
No
Full-Time
Employment
Part-Time
Employment
College
Internship
High School
Internship
Yes
No
20+ Hours
32+ Hours
40+ Hours
45+ Hours
50+ Hours
Other:
Yes
No
 
EMPLOYMENT HISTORY
(List Last Three (3) Positions Held, Starting With Most Recent)
Make sure the starting and ending months are listed.
Yes
No

Yes
No

Yes
No
 
EDUCATIONAL BACKGROUND
List last three (3) schools attended, starting with most recent.
List number of years completed. Indicate degree or diploma earned, if any. Grade Point Average (GPA)
or Class Rank. Major/Field Of Study. Minor/Field Of Study (If Applicable) (N/A).


 

REFERENCES
List name and telephone number of three business/work references who are not related to you and are not previous
supervisors. If not applicable, list three school or personal references who are not related to you.

 

 

ADDITIONAL INFORMATION
Please list professional, trade, business or civic associations and any offices held.
EXCLUDE memberships that would reveal race, color, religion, gender, national origin, citizenship, age, mental or physical disabilities, veteran/reserve, national guard or any other similarly protected status.

 

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APPLICANT CERTIFICATION OF INFORMATION
 

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

 

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered.

 

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

 

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

 

I understand that this application remains current for only 30 days. At the conclusion of that time, If I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

 

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.

 

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

 
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
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