APPLICATION FOR EMPLOYMENT
Thank you for your interest in employment with our organization. We are an equal opportunity employer that complies with all federal, state, and local laws that prohibit discrimination on the basis of sex, age, race, national origin, religion, color, marital status, veteran’s status, medical condition or any other protected categories covered by law.
Position applying for: |
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Date of Application: |
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Hourly Wage/Salary |
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Desired: |
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How were you referred to our organization: |
Website |
Teamworkonline.com |
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Walk-in |
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Referral: |
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Name (Last) |
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(First) |
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(Middle) |
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Current Address |
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City |
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State |
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ZIP |
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Telephone Number: |
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Alternate Telephone Number: |
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Email Address: |
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( |
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( |
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Have you ever been employed with this organization |
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If seeking part time work, list your hours of availability: |
before? |
Yes |
No |
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If yes, please give date: |
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Mon: |
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Tues: |
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Wed: |
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Thurs: |
Are you currently employed? |
Yes |
No |
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Fri: |
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Sat: |
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May we contact your present employer? |
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Yes |
No |
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Sun: |
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Are you available to work nights and weekends: |
If hired, can you provide proof that you are eligible to work |
Yes |
No |
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in the United States? |
Yes |
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No |
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Have you ever been convicted of a criminal offense (felony |
Are you at least 18 years of age or older? |
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Yes |
No |
or misdemeanor)? Convictions for marijuana related |
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offenses that are more than 2 years old need not be listed. |
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Yes |
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No |
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On what date would you be available to start |
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work? |
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If yes, please explain. A “yes” answer is not an automatic |
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bar to employment. State nature of crime(s), when and |
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where convicted. |
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Are you applying for: |
Full-time work |
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Part-time work |
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Temporary/Seasonal work |
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EDUCATION
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Name |
Graduated |
Degree(s) |
Major Field(s) of Study |
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(Please also provide City and State) |
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Certificate(s) |
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High School |
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Yes |
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or |
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No |
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Trade School |
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College |
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Yes |
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No |
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College |
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Yes |
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No |
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Other |
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Yes |
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No |
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Please list any other job related training, skills or qualifications, including fluency in other languages, licenses, etc. that you feel may be relevant to the position applied:
PROFESSIONAL REFERENCES
List below three people who have worked with you in the past and are not related to you who can comment on your professional character and work experience.
EMPLOYMENT HISTORY
Please list your work experience beginning with your most recent employer. Treat/list Military Service as work experience. You must complete this section even if attaching a resume.
Employer |
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Dates Employed |
Description of Job Duties: |
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From |
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To |
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Title |
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Salary |
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Starting |
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Ending |
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Telephone Number ( |
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Address |
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Supervisor’s Name & Title |
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Reason for leaving |
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Employer |
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Dates Employed |
Description of Job Duties: |
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From |
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To |
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Title |
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Salary |
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Starting |
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Ending |
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Telephone Number ( |
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Address |
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Supervisor’s Name & Title |
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Reason for Leaving |
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Employer |
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Dates Employed |
Description of Job Duties: |
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From |
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To |
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Title |
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Ending |
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Telephone Number ( |
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Address |
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Supervisor’s Name & Title |
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Reason for Leaving |
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Employer |
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Dates Employed |
Description of Job Duties: |
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From |
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To |
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Title |
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Salary |
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Starting |
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Ending |
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Telephone Number ( |
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Address |
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Supervisor’s Name & Title |
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Reason for Leaving |
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3 |
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Explain any gaps in employment:
APPLICANT’S STATEMENT
Please read all of the following statements carefully and ask questions if you need clarification before you sign this section.
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the information/answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
If I am hired by Company, I understand and agree that:
1.I shall preserve in strict confidence all information concerning the business of Company and its customers.
2.During my employment with Company, I shall not accept or hold employment with others that would create a conflict of interest.
3.If employed by Company, I agree to conform to the guidelines and policies of Company. I understand that I or Company may terminate my employment at any time, with or without cause, and that any assurances of continued employment, whether written, oral or by conduct, shall not be interpreted as changing the "at will" nature of my employment relationship with Company, unless specifically acknowledged in writing by an officer of Company. I further understand that Company may also demote or discipline me, or reassign my job responsibilities for any reason, at its sole discretion.
4.If employed in the U.S., I understand that as a condition of employment I will be required to provide proof of U.S. Citizenship, U.S. permanent residency or authorization to work in the U.S. and personal identification.
5.Company will conduct a routine investigation in connection with my employment including but not limited to a criminal record check or any condition allowed by law.
6.I authorize Company to verify all references and information provided by me in this application and release Company, and any person or company responding to any reference or request for information from any claim or liability regarding any information or opinion supplied. I understand that any offer of employment is subject to satisfactory references.
7.If I am hired, I will be required to sign an Employment Agreement that includes confidentiality, assignment of inventions and mandatory arbitration provisions. (Not applicable for part-time positions)
8.All the foregoing terms and conditions will become part of my employment agreement with Company if I am employed by Company.
SIGNATURE OF APPLICANT: |
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DATE: |
Revised September 2010
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