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Application for Employment

Instructions: Complete all necessary information. You may be asked to provide additional information on another form. This application will be kept on file. It is your advantage to periodically check to keep it current and active. Be sure to initial and date this application.

* Indicates Required Field

Name:
Social Security #:
Phone: Format: 999-999-9999
Address:
City: State: Zip:
Email:

Position applied for:

Would you accept seasonal work?
Yes No

Would you accept full-time work?
Yes No

Would you accept part-time work?
Yes No

Have you ever been employed here before?
Yes No

If yes, please give approximate dates of prior employment of this company

Attach Resume

Educational Background

High School	9	10	11	12
College	1	2	3	4
Graduate School	Masters		PHD

Vocational training?
Graduate degree?
Training in what field?

Name of last school attended:

Personal References

(Other than family members or previous employers)

1.	Name Phone Address
2.	Name Phone Address
3.	Name Phone Address

Previous Employers and Their Addresses

Click on box by each employer that you do not want us to contact.
List the most recent employer first.

1.	Company Name Phone Address Employed From To Position Reason for Leaving Last Wage
2.	Company Name Phone Address Employed From To Position Reason for Leaving Last Wage

Do you have a legal right to be employed in the U.S.?
Yes No (If yes, proof is required)

Are you of legal age to work?
Yes No

Additional Information

To The Applicant: Read this section carefully before answering any of the questions in this area. Answer the following questions only if the red box on the left of a question is checked. The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex, or national origin. Federal law also prohibit other types of discrimination, such as age, citizenship, disability, veteran status, attainment of benefits, or participation in union activities. The laws of many states and localities also prohibit some or all of these types of discrimination, as well as prohibiting additional types of discrimination, such as discrimination based on ancestry, parental or marital status, sexual orientation, or source of income.

You acknowledge that there is a written job description for the position you have applied for on this website which includes the essential job functions for the position.
Are you able to preform each of the essential job functions listed for this position with or without accommodation? Yes No
If you can preform the job functions with an accommodation, please describe how you would perform the functions and with what accommodations.

I understand that the Immigration Reform and Control Act of November 6, 1986 requires me to prove the legality of my residency or citizenship. I am also aware that the failure to provide such proof at the time of request may legally force my termination. To the best of my knowledge the information contained on this application is true. I understand that nothing contained in this employment application or in the granting of an interview is intended to create a contract between me and this company for either employment or the provision of any benefits; and further understand that if an employment relationship subsequently is established, I will have the right to terminate my employment at any time and the company will have a similar right. In addition, I understand that no promise, representation or agreement contrary to the foregoing is binding on the company unless made in writing and signed by me and an authorized representative of the company.

Applicant's Initials (for proof of accuracy)    Date