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Employment
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Application
Applicant Information
Position applying for:
Date
MM slash DD slash YYYY
Are you seeking a new job currently?
Yes
No
How did you find this job:
Newspaper
Employee
Walk-In
Relative
Name
First
Middle
Last
Phone
Email:
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
If Hired, Do you have a reliable means of transportation to get to work?
Yes
No
Can you describe:
Are you 18 years old?
Yes
No
if you are under 18, Can you furnish a work permit?
Yes
No
If the job you are applying for requires driving: Drivers License No.
Issuing State:
Expiration Date
MM slash DD slash YYYY
Are you Legally Eligible for employment in the U.S.?
Yes
No
Have you been convicted of a crime? (Massachusetts applicants should not include misdemeanor convictions; California applicants should not in- clude marijuana-related convictions that occurred more than 2 years prior to the application date.)
Yes
No
If yes, state the nature of the offense and disposition of the case. Include dates and places. (NOTE: The existence of a criminal record does not constitute an automatic bar to employment.)
Are you a veteran?
Yes
No
If yes, Give dates of service:
Any special skills or training:
Employment Information
What hour(s)/Shift(s) would you prefer to work?
What type of employment are you seeking?
Full-Time
Part-Time
Temporary
List times you are not available to work?
are you willing to work:
Overtime
Weekends
Holidays
Are you currently employed?
Yes
No
If hired, when can you start?
Have you worked for this organization before?
Yes
No
If Yes, name used:
List any friends or relatives employed by this company:
Have you ever been discharged or asked to resign from any position?
Yes
No
If yes, please describe:
Education (circle highest level achieved)
Elementry
1
2
3
4
5
6
7
8
Secondary:
9
10
11
12
G.E.D.
College:
1
2
3
4
5
6
7
8
Name of School:
Name of School:
Name of School:
Location of School:
Location of School:
Location of School:
Degree & Major:
Minor:
If in high school, are you enrolled in a recognized co-op program?
Yes
No
If yes, identify program and school:
Work History
Job #1
Company
Phone Number
Address
Dates of Employment: From
To
Salary:
Title
Supervisor's Name & Title
Describe Duties:
Reason for Leaving:
Job #2
Company
Phone Number
Address
Dates of Employment: From
To
Salary:
Title
Supervisor's Name & Title
Describe Duties:
Reason for Leaving:
Job #3
Company
Phone Number
Address
Dates of Employment: From
To
Salary:
Title
Supervisor's Name & Title
Describe Duties:
Reason for Leaving:
For references purposes: Have you worked for any of these organizations or attended school under a different name?
Yes
No
If yes, give name and organization(s)
May we contact the employers listed above?
Yes
No
If not, list the employers you do not wish us to contact and why:
Authorizations & At-Will Employment Agreement
I certify that I have personally completed this application. I declare that the information provided in this employment application is true and complete and I understand that any false information or significant omissions may disqualify me from further consideration for employment and may be justification form my dismissal from employment if discovered at a later date. I agree to immediately notify this company if I should be convicted of a crime while my job application is pending or during my employment, if hired. I authorize this company to make an investigation of all information contained in this employment application and I release from liability all companies and corporations supplying such information. I understand any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or dis- charge. I specifically authorize and direct my current and former employers to supply employment-related information to this company and do hereby release my current and former employers from liability for providing information to this company. Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer. I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and any other investiga- tive report deemed necessary through various third party sources. As required by law, upon request within a reasonable period of time, I will be notified as to the nature and scope of such investigations. I hereby agree to submit to any drug test required of me, whether prior to my employment or if employed by this company at any time thereafter. If requested, I will take a post-job offer physical examination and my employment, in the event I receive medical treatment for any condition, including a physical, psychological, emotional, or psychiatric condition that is job-related, I hereby authorize the limited release and exchange of such medical information relating to my condition between the treatment provider and a company-designated physician. AT-WILL EMPLOYMENT AGREEMENT I understand and agree that nothing contained in this application, or conveyed during any interview is intended to create an em- ployment contract between the company and me. In addition, I understand and agree that if you employ me, in consideration of my employment, my employment and compensation will be at-will, for no definite period of time, and may be terminated at any time, for any reason, or for no reason at all. I understand that only the company’s President is authorized to change the employment-at-will status and such a change can only be done in writing. I have read, understand, and agree to the above.
(Required)
Yes, I agree
No, I don't agree
Signature
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