Employment Application


Applicant Information

Full Name:

     

Date:

Address:

    

   

Phone:    Email:   

Social Security No: 

 Date Available: 

Position Applied For:  Desired Annual Income:   

Employment Desired:   

Do you have a valid and current driver’s license?   

Do you have reliable transportation to and from work?   

Have you had any accidents during the past three years?    

If yes to above, how many?    

Have you had any moving violations during the past three years?  

If yes to above, how many?  

Are you a citizen of the United States?    

If no to above, are you authorized to work in the U.S.?   

Have you ever been convicted of a felony?   

If yes to above, explain:

 

Education

Have you had CPR / First Aid Training?   

Are you CPR / First Aid Certified?    

Please list any other training or certifications:

High School:   

Did you Graduate from High School:    

Highest Grade Level Achieved:   

College:  Address:   

From:   To: 

Did you graduate?    

Degree:    

 

References

Please list three professional references:

Reference 1:

Full Name: Relationship:   

Company:  Phone:   

Address:  

Reference 2:

Full Name:    Relationship:

Company: Phone:   

Address:   

Reference 3:

Full Name: Relationship:   

Company:  Phone:   

Address:   

 

Previous Employment

Five years, beginning with most recent: 

Employment 1

Company:  Phone:   

Job Title:  

Address:  Supervisor:

Starting Pay $: Ending Pay $:   

Responsibilities: 

From:   To: 

Reason For Leaving: 

May we contact your supervisor for a reference?   

 

Employment 2

Company:   Phone:    

Job Title:   

Address:   Supervisor:   

Starting Pay $:   Ending Pay $:   

Responsibilities: 

From:   To: 

Reason For Leaving: 

May we contact your supervisor for a reference?   

Employment 3

Company:    Phone:   

Job Title:   

Address:   Supervisor:   

Starting Pay $:    Ending Pay $:   

Responsibilities:

From:  To:  

Reason for Leaving: 

May we contact your supervisor for a reference?   

 

Military Service

Branch:   

From:  To: 

Rank at Discharge:   Type of Discharge:   

If above answer is other than honorable, explain: 

 

Disclaimer and Acknowledgement

Applicant Waiver

(All job applicants must sign and submit with application form)

I hereby certify that the information hereunder is correct to the best of my knowledge and understand that falsification of this information is grounds for refusal to hire or, if hired, dismissal. 

I hereby authorize any of the persons or organizations listed in my application to give all information concerning my previous employment, education, or any other information that might have, personal or otherwise, with regard to any of the subjects covered by this application, and release all such parties from all liability that may result from furnishing such information to you. I authorize you to request and receive such information. 

In consideration for my employment and my being considered for employment by your company, I agree to adhere to the rules and regulations of the company and hereby acknowledge that these rules and regulations may be changed by your company at any time, at the company’s sole option and without any prior notice. In addition, I acknowledge that my employment may be terminated, and any offer of employment, if such is made, may be withdrawn with or without prior notice, any time, at the option of either the company or me. 

I understand that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to assure or make some other personnel move, either prior to commencement of employment or after I have become employed, or to assure any benefits or terms and conditions of employment, or to many any agreement, that is contrary to the foregoing. 

I hereby acknowledge that I have been advised that this application will remain active for no more than 90 days from the date it was signed. 

By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application. 

 

 

 

 

 

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Signature Certificate
Document name: Employment Application
Unique Document ID: b6fd395bb185230ca485d830d67e1b1a655f1383
Timestamp Audit
October 4, 2018 11:54 am EDTEmployment Application Uploaded by Ed McNulty - staff@tricountyninja.com IP 97.84.201.94