Employment Application
This is a Drug-Free Workplace Offering Equal Employment Opportunities. Applications are received and employees are hired without regard to race, color, sex, religion, age, genetic information, national origin, disability, veteran’s status, citizenship status, or any other protected classes under state, local, or county regulations. The receipt of this application does not mean that job openings exist and does not obligate us in any way. We appreciate your interest in our organization.
Your Personal Information
Your Work History And Any Employment Gaps
Must be completed even when accompanied by resume. List most recent or current job first. You must include any gaps in employment, with a full explanation and dates for the gap. You must also provide a complete work history for a minimum of seven years. If you need more space, photocopy page 2 or fill out a separate page and attach it to this form.
Employer #1
Employer #2
Employer #3
Tell Us About Yourself
You must answer every question on this application. If a question does not apply, put "N/A".
Are you available to work (Check any that apply):
Are there any days or times during the week that you are not available to work?
If yes, please list the days/times you are not available to work:
If necessary, can you provide proof that you are over any minimum work age requirement?
Are you willing to work overtime?
Do you have steady transportation to work?
What percentage of the time can you travel?
Are you on a layoff and subject to recall?
May we contact your present employer?
How much time have you lost from work in the past 12 months?
Are you now, or do you expect to be, engaged in any other business or employment while working here?
If yes, please explain.
Are you presently an officer, employee, or employer of another business in our industry or with whom we compete?
If yes, please explain.
Please list any business that you own or have a majority interest in.
Have you ever been terminated from employment or asked to resign from a job?
If yes, please explain.
Why do you desire to make a change?
Are you legally eligible to work in the United States? (Proof of status/identity required upon hire)?
What three things are most important to you in a job?
What three adjectives best describe you?
Why type of work do you most enjoy?
Why do you want to work here?
Have you ever been a customer of ours?
If yes, what services did you receive?
Tell Us About Your Special Skills and Qualifications
Your Educational Background
Tell Us About Your Driving Record
Necessary for positions that may require use of a personal or company vehicle for work
Military Service
Non-Compete Agreement
Tell Us About Your Past
Answering “yes” to any of these questions is not an automatic bar to employment.
Agreement and Release
For the purpose of this agreement and release, the organization that has provided you with this application is referred to as “the company,” “this company,” or “you” in the following paragraphs:
The facts set forth above in my application for employment are true and complete. I understand that false statements or omission of information on this application (even if discovered after employment) or any other employment form may lead to dismissal or denial of employment. You are hereby authorized to make any investigation of my personal history, financial, criminal, credit, and motor vehicle records through any investigative or credit agencies or bureaus of your choice. You are also authorized to administer a personality profile or other pre-employment tests and verify my background. A criminal record or sentence is not an automatic disqualification for employment. I agree to submit to any drug or alcohol testing prior to or after employment.
In making this application for employment, I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. I also acknowledge that the company may conduct a search for information about me that is in the public domain, including, but not limited to, information on social networking sites. In exchange for the consideration of my employment application by this company, I hereby release and forever discharge this company (including its directors, officers, employees, and agents) and my past and/or present employers (including their directors, officers, employees, and agents) from any liabilities which may result from an investigation of my past and/or present employment or from the disclosure of such information. I authorize the use of any information in this application to verify my statements, and I authorize past employers, doctors, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record.
I understand that if my application is accepted and if I am hired, employment with this company at all times is employment “at will.” It is further understood that this “at will” relationship may not be changed by any written document, verbal statements, or by conduct unless an authorized executive of this company specifically acknowledges such change. I further understand that my “at will” employment may be terminated at any time by this company or myself and includes no guarantee, contract, or promise of employment for any specific length of time. I understand that the first 90 days of employment is a new-hire introductory period. Submission of this application does not imply that I will be hired.
