Standard Application for Employment

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications.

Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application. You may attach a résumé, but all questions must be answered

Employer

Position applying for

PERSONAL DATA

Name (last, first, middle)

Address

Home Telephone Number

Cellular Telephone Number

Date you can start work

Salary Desired

Do You have a High School Diploma or GED?

POSITION INFORMATION

Check all that you are willing to work

Hours

Status

Regular

Temporary

Are you authorized to work in the U.S. on an unrestricted basis?

Yes

No

Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.)

Yes

No

Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job?

Yes

No

Can you perform these essential functions of the job with or without reasonable accommodation?

Yes

No

QUALIFICATIONS

School Name

Degree

Address/City/State

School Name

Degree

Address/City/State

Other

Degree

Address/City/State

Special Skills

REFERENCES

Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don’t have three professional references, then list personal, unrelated references.

Name

Address

Phone

Relationship

Name

Address

Phone

Relationship

Name

Address

Phone

Relationship

WORK HISTORY

Start with your present or most recent employment and work back. Upload a separate sheet if necessary. (INCLUDE PAID AND UNPAID POSITIONS)

Job Title #1

Company Name

Reason for Leaving

Start Date

End Date

Supervisors Name

Supervisor Phone

City

State

Zip

Starting Salary

Ending Salary

Upload resume and any supporting documents