Print a blank job application.
APPLICATION FOR EMPLOYMENT
     
An Equal Opportunity Employer:
We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.
Instructions:
Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.
Job Applied for Today's Date
What employment are you seeking?   Full-Time Part-Time Temp. When could you start
Desired Salary hour Email
Last Name First Name
Middle Name Telephone Number
Present Street Address City
State Zip
Are you 18 years of age or older? Yes:  No: (If you are hired, you may be required to submit proof of age.)
Social Security#(optional)
If hired, can you furnish proof you are eligible to work in the U.S.? Yes:  No:
Have you ever applied here before? Yes:  No: If yes,when?
Were you ever employed here? Yes:  No: If yes,when?
Have you ever been convicted of any law violation (Include any plea of "guilty" or "no contest". Exclude minor traffic violations) Yes:  No:
If yes, give details
(A conviction will not necessarily disqualify an applicant for employment.)
If employed, do you expect to be engaged in any additional business or employment outside of our job? Yes:  No:
If yes, please explain
Do you have a valid driver's license? Yes:  No: Driver's License Number
Class of License State Licensed In
Have you had your driver's license suspended or revoked in the last three years? Yes:  No:
If yes, give details
  List Name and Address of Schools Number of years completed/ Diploma/Degree Certificate Subjects Studied
High School or GED:
College or University:
Vocational or Technical:
What skills or additional training do you have that relate to the job for which you are applying?
 
What machines or equipment can you operate that relate to the job for which you are applying?
 
List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. Note: A job offer may be contingent upon acceptable references from current and former employers.

Name of Employer Job Title and Duties
Address
City, State, Zip Code Employed From - To (Month,Year)
Supervisor Telephone
Your Final Pay Your Starting Pay
Reason for Leaving

Name of Employer Job Title and Duties
Address
City, State, Zip Code Employed From - To (Month,Year)
Supervisor Telephone
Your Final Pay Your Starting Pay
Reason for Leaving

Name of Employer Job Title and Duties
Address
City, State, Zip Code Employed From - To (Month,Year)
Supervisor Telephone
Your Final Pay Your Starting Pay
Reason for Leaving

Name of Employer Job Title and Duties
Address
City, State, Zip Code Employed From - To (Month,Year)
Supervisor Telephone
Your Final Pay Your Starting Pay
Reason for Leaving
Have you worked or attended school under any other name? Yes:  No:
If yes, give names:
Are you presently employed? Yes:  No:
If yes, whom do you suggest we contact?
Have you ever been fired from a job or asked to resign? Yes:  No:
If yes, please explain:
Give three references, not relatives or former employers.

Name Phone
Address

Name Phone
Address

Name Phone
Address
PLEASE READ EACH STATEMENT CAREFULLY BEFORE SUBMITTING
I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.
I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers, and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.
I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required.
I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.
I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENT OF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE.
I have read, understand, and by my signature consent to these statements
Signature
Date