Employee Application

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EMPLOYMENT / JOB APPLICATION PERSONAL INFORMATION FULL NAME: ___________________________________ DATE: __________________ First Middle Last ADDRESS: _____________________________________________________________ Street Address Apt/Suite _____________________________________________________________ City State Zip Code E-MAIL: __________________________________ PHONE: _____________________ SOCIAL SECURITY NUMBER (SSN): _____-____-_____ DATE AVAILABLE: __________________ DESIRED PAY: $_________ ☐ HOUR ☐ SALARY POSITION APPLIED FOR: _________________________________________________ EMPLOYMENT DESIRED: ☐ FULL-TIME ☐ PART-TIME ☐ SEASONAL EMPLOYMENT ELIGIBILITY ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S? ☐ YES ☐ NO* HAVE YOU EVER WORKED FOR THIS EMPLOYER? ☐ YES* ☐ NO *IF YES, WRITE THE START AND END DATES: ____________________________________ HAVE YOU EVER BEEN CONVICTED OF A FELONY? ☐ YES* ☐ NO *IF YES, PLEASE EXPLAIN: ____________________________________________________ EDUCATION HIGH SCHOOL: _____________________ CITY / STATE: _____________________ FROM: _____________________ TO: _____________________ GRADUATE? ☐ YES ☐ NO DIPLOMA: _____________________ COLLEGE: _____________________ CITY / STATE: _____________________ FROM: _____________________ TO: _____________________ GRADUATE? ☐ YES ☐ NO DEGREE: _____________________ OTHER: _____________________ CITY / STATE: _____________________ Page 2 of 4 FROM: _____________________ TO: _____________________ DEGREE/CERTIFICATION: _____________________ OTHER: _____________________ CITY / STATE: _____________________ FROM: _____________________ TO: _____________________ DEGREE/CERTIFICATION: _____________________ PREVIOUS EMPLOYMENT EMPLOYER 1: __________________________________________________________ Company / Individual E-MAIL: __________________________________ PHONE: _____________________ ADDRESS: ____________________________________________________________ Street Address Apt/Suite ____________________________________________________________ City State Zip Code STARTING PAY: $_________ ☐ HOUR ☐ SALARY ENDING PAY: $_________ ☐ HOUR ☐ SALARY JOB TITLE: ______________ RESPONSIBILITIES: _____________________________ FROM: _____________________ TO: _____________________ REASON FOR LEAVING: _______________________________________________________ EMPLOYER 2: __________________________________________________________ Company / Individual E-MAIL: __________________________________ PHONE: _____________________ ADDRESS: ____________________________________________________________ Street Address Apt/Suite ____________________________________________________________ City State Zip Code STARTING PAY: $_________ ☐ HOUR ☐ SALARY ENDING PAY: $_________ ☐ HOUR ☐ SALARY JOB TITLE: ______________ RESPONSIBILITIES: _____________________________ FROM: _____________________ TO: _____________________ REASON FOR LEAVING: _______________________________________________________ EMPLOYER 3: __________________________________________________________ Company / Individual Page 3 of 4 E-MAIL: __________________________________ PHONE: _____________________ ADDRESS: ____________________________________________________________ Street Address Apt/Suite ____________________________________________________________ City State Zip Code STARTING PAY: $_________ ☐ HOUR ☐ SALARY ENDING PAY: $_________ ☐ HOUR ☐ SALARY JOB TITLE: ______________ RESPONSIBILITIES: _____________________________ FROM: _____________________ TO: _____________________ REASON FOR LEAVING: _______________________________________________________ REFERENCES (PROFESSIONAL ONLY) FULL NAME: _______________________________ RELATIONSHIP: ______________ First Last COMPANY: ________________________________ TITLE: ______________ E-MAIL: __________________________________ PHONE: _____________________ FULL NAME: _______________________________ RELATIONSHIP: ______________ First Last COMPANY: ________________________________ TITLE: ______________ E-MAIL: __________________________________ PHONE: _____________________ FULL NAME: _______________________________ RELATIONSHIP: ______________ First Last COMPANY: ________________________________ TITLE: ______________ E-MAIL: __________________________________ PHONE: _____________________ MILITARY SERVICE ARE YOU A VETERAN? ☐ YES ☐ NO BRANCH: _____________________ RANK AT DISCHARGE: _____________________ FROM: _____________________ TO: _____________________ TYPE OF DISCHARGE: _____________________ IF NOT HONORABLE, PLEASE EXPLAIN: ______________________________________ BACKGROUND CHECK CONSENT IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK? ☐ YES ☐ NO DISCLAIMER Applicant understands that this is an Equal Opportunity Employer and committed to excellence through diversity. In order to ensure this application is acceptable, please print or type with the application being fully completed in order for it to be considered. Please complete each section EVEN IF you decide to attach a resume. I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated. SIGNATURE _________________________________ DATE _____________________