Employment Application

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 years.

Personal Information

First Name

Middle Name

Last Name

Home Phone

Work Phone

Cell Phone

Email Address

Addresses

Current Address 1

Street

City

State

Zip Code

Since (Mo/Yr)

To (Mo/Yr)

Prior Address

Street

City

State

Zip Code

Since (Mo/Yr)

To (Mo/Yr)

Prior Address

Street

City

State

Zip Code

Since (Mo/Yr)

To (Mo/Yr)

Education

School Attended

City

State

Diploma

Degree/Cert.

Area of Study

High School

School Attended

City

State

Diploma

No Yes

GED

Undergrad School

School Attended

City

State

Diploma

No Yes

Degree/Cert.

Area of Study

Grad School

School Attended

City

State

Diploma

No Yes

Degree/Cert.

Area of Study

Other School

School Attended

City

State

Diploma

No Yes

Degree/Cert.

Area of Study

Employment History

Are you currently employed?

No Yes

May we contact your present employer?

No Yes

Most Recent Employer

Employer

City

State

Zip Code

Phone

Position Held

From (m/yyyy)

To (m/yyyy)

Pay upon leaving

Supervisor

Duties

Reason for Leaving

Prior Employer 1

City

State

Zip Code

Phone

Position Held

From (m/yyyy)

To (m/yyyy)

Pay upon leaving

Supervisor

Duties

Reason for Leaving

Prior Employer 2

City

State

Zip Code

Phone

Position Held

From (m/yyyy)

To (m/yyyy)

Pay upon leaving

Supervisor

Duties

Reason for Leaving

Prior Employer 3

City

State

Zip Code

Phone

Position Held

From (m/yyyy)

To (m/yyyy)

Pay upon leaving

Supervisor

Duties

Reason for Leaving

Job-related Skills

Please answer the following questions if the position you are applying for requires driving a motor vehicle

Do you have a valid driver's license?

No Yes

If yes, Driver's License Number

Date of Issue

Have you been convicted of or pled guilty to any traffic-related offense within the past five years?

No Yes

If yes, please explain...

Have you had your driver's license suspended or revoked or had your driving privileges modified by a court of law?

No Yes

If yes, please explain...

Please list all states from which you hold or held a driver's license

Please use this space to list any special skills you may have that relate to the position applied for

Please list any professional licenses, designations, certifications, etc. that may relate to the position applied for. Include date granted, name of organization, and any other relevant information.

References

Reference 1

Name

Address

Telephone

Relationship

Years Acquainted

Reference 2

Name

Address

Telephone

Relationship

Years Acquainted

Reference 3

Name

Address

Telephone

Relationship

Years Acquainted

Reference 4

Name

Address

Telephone

Relationship

Years Acquainted

Resume (Text Version)

Copy and Paste a text version of your resume here.

Upload File

Attach a file to your application submission (Permitted File Types: doc,docx,pdf,txt - Max file size: 1045876 bytes)

Applicant Certification Agreement

The company and other persons or employers are released from all liability brought forth by any investigation resulting from my submission of this electronic application and the data contained here in.

The information in this application is true and complete to the best of my knowledge. Any falsification, misrepresentation, or omission on this application can be cause for denial or termination of employment.

If hired, my employment is voluntary, meaning that either party can employment at any time for any reason. Upon acceptance of employment if a position is offered, I agree to abide by all existing and future company rules and regulations. The company reserves the right to change any working agreement as deemed necessary.

Any employment offer is contingent open my providing proof of identity and eligibility to work the country of employ.

I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.

I understand that by typing my name in the signature box below and submitting this application electronically, this becomes a legal and binding contract.

Security Code

	Type Name in Signature Box:	Date: 2020-10-21 21:01:44

Testimonials

A week before Christmas, I woke in the middle of the night to find my kitchen ceiling, upstairs landing, main floor and basement flooded. Ted was … read more

Carrie

Burlington

Show More Testimonials