Employment Application

Equal access to programs, services, and employment is available to all persons. Those applicants requiring reasonable accomodation to the application and/or interview process should notify a representative of the Human Resources Department

Positions(s) Applied For
 
 
Date Of Application
Name
Social Security Number
Address
 
City
State
ZIP
Telephone
FAX/Beeper/Mobile
E-Mail Address
If You Are Under 18, Can You Furnish A Work Permit? YES NO
If No, Please Explain
Have You Ever Been Employed Here Before? YES NO
If Yes, Give Dates and Positions
Are You Legally Eligibile For Employment In This Country? YES NO
Date Available For Work
Desired Salary Range
Type Of Employment Desired Full-Time Part-Time Temporary Seasonal
Are You Able To Meet Attendance Requirement Of The Position YES NO
Have You Ever Pled "Guilty," or "No Contest" to, or Been Convincted Of A Crime? YES NO
If Yes, Please Provide Date and Details
Driver's License Number
State

Answering "Yes" To These Questions Does Not Constitute An Automatic Bar To Employment. Factors Such As Date of the Offense, Seriousness and Nature of the Violation, Rehabilitation, and Position Applied For Will be Taken Into Account

Provide the following information of your past four (4) employers, assignments, or volunteer activities, starting with the most recent.

#1

  
Dates
Employer
Telephone
Starting Job Title/Ending Job Title
Address
 
City
State
Zip
May We Contact For Reference? YES NO
Reason For Leaving
Hourly Rate/Salary: Start
Hourly Rate/Salary: Finish

#2

  
Dates
Employer
Telephone
Starting Job Title/Ending Job Title
Address
 
City
State
Zip
May We Contact For Reference? YES NO
Reason For Leaving
Hourly Rate/Salary: Start
Hourly Rate/Salary: Finish

#3

  
Dates
Employer
Telephone
Starting Job Title/Ending Job Title
Address
 
City
State
Zip
May We Contact For Reference? YES NO
Reason For Leaving
Hourly Rate/Salary: Start
Hourly Rate/Salary: Finish

#4

  
Dates
Employer
Telephone
Starting Job Title/Ending Job Title
Address
 
City
State
Zip
May We Contact For Reference? YES NO
Reason For Leaving
Hourly Rate/Salary: Start
Hourly Rate/Salary: Finish

Skills and Qualifications

Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job related functions in the position for which you are applying.

Educational Background

Name/Location of School
Years Completed
Graduate? Degrees?
Course of Study

References

Name
Telephone Number
Years Known

Application Statement

I certify that all information I have provided in order to apply for and secure work with th 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 out without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without prior notice, except as may be required by law. This application does not constitute an agreement to 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 an officer of the employer.

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 and I-9 Form in this regard.

I CERTIFY THAT I HAVE READ, FULLY UNDERSTAND, AND ACCEPT ALL TERMS OF THE FOREGOING APPLICANT STATEMENT
YES

Press SUBMIT to send your application