APPLICATION FOR EMPLOYMENT

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, martial or veteran status, the presence of a non job related medical condition or handicap, or any other legally protected status.  Proof of citizenship or immigration status will be requested upon employment

(PLEASE TYPE OR PRINT)
 

      Position Applied For                                                     Date of Application  

Last Name                                    First Name                              Middle Name or Initial

Address                                                City                     State                 Zip Code

Telephone Number(s) (indicate home or work)

Social Security Number

Date Available:___________  Are you available:  __Full Time __Part Time __Weekends

Have you been convicted of a felony within the past 7 years?    __Yes   __No
         Conviction will not necessarily disqualify an applicant from employment.
If Yes, attach explanation.

Education

High School

Undergraduate

Graduate

School Name & Location

Years Completed
 

1   2   3   4

1   2   3   4

1   2   3   4

Diploma/Degree

Course of Study

State any additional information you feel may be helpful to us in considering your application (such as any specialized training; skills; apprenticeships; honors received; professional, trade, business, or civic organizations or activities; job-related military training or experience; foreign language abilities; etc.)

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Employment History (Last Employer First)

Dates

Employers Name and Address

Kind of Work

Salary

Reason for Leaving

From

$

To

Per

From

$

To

Per

From

$

To

Per

From

$

To

Per

Additional Remarks

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____________________________________________________________________________
____________________________________________________________________________
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Do you have the legal right to reside and work in the United States?

Yes __

Proof of citizenship or immigration status may be required upon employment

No  __

Applicant's Statement

    I certify that the information given on this application is true and complete to the best of my knowledge.  I authorize investigation of all statements contained in this application, and understand that false or misleading information given in my application or interview(s) may result in discharge.
    I understand and acknowledge that, unless otherwisde defined by applicable law, any employment relationship with this organization is "at will", which means that I may resign at any time and the employer may discharge me at any time with or without cause.  I further understand that this "at will" employment relationship may not be changed orally, by any written document, or by conduct, unless such change is specifically acknowledged in writing by an authorized executive of the organization.

_____________________________                                        _________________
Signature of Applicant                                                                  Date

APPLICATION FOR EMPLOYMENT