Employment Application

Logged in as Guest

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 1 year.

Personal

Addresses

Current Address
Prior Address

Education

High School / GED
College / Vocational

Employment

Employment Information
 (yyyy-mm-dd)
 Nights  Evenings
 M  Tu  W  Th  F  Sa  Su
Please answer all of the following questions.
1) Are you legally eligible to work for our company in the United States?
If you are under 18 years of age, and it is required, can you provide a work permit?
2) Have you worked for this business before?
If yes, please provide dates and locations.
3) Have you received a description of the job or been made aware of the essential functions of the job for which you are applying?
4) Are you able to perform the "essential functions" of the job for which you are applying, with or without reasonable accomodation?
If no, please explain.
5) Are you on layoff and subject to recall?
6) Are you currently bound by a noncompetition, confidentiality or trade secret agreement?
If yes, please explain...
7) Have you ever been discharged or asked to resign from a job?
If yes, please explain...
8) Do any of your friends or relatives, other than spouse, work here?
If yes, state name and relationship...

Employers

Are you currently employed?
May we contact your present employer?
Current / Most Recent Employer
Prior Employer
Prior Employer
Prior Employer

Skills

Job-related Skills

References: Please note references should be former supervisors that can accurately evaluate your work performance.

Reference
Reference
Reference
Reference

Resumes

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)

Agreement

Applicant Certification Agreement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.

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, resumé 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 truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any 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 for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or 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 the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an 1-9 Form in this regard.

This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status. Examples of prohibited harassment include, but are not limited to, unwelcome physical contact, offensive gestures, unwelcome comments, jokes, epithets, threats, insults, name-calling, negative stereotyping, possession or display of derogatory pictures or other graphic materials, and any other words or conduct that demean, stigmatize, intimidate, or single out a person because of his/her membership in a protected category. Harassment of our employees is strictly prohibited, whether it is committed by a manager, coworker, subordinate, or non-employee (such as a vendor or customer). The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.

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) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

Security Code
 
Security Code
 
  captcha
Signature
 
Type Name in Signature Box*:
 
 
Date: 2018-11-12 12:37:13
Powered by JobGrok