Employment Application Form

Employment Application
Personal Information:
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail
Do you have a current and valid driver's license?*

YesNo
Driver's License Number*
Birth Date*

MonthDayYear
Are You a U.S. Citizen?*

YesNo
If you are not a citizen of the Unites States, are you legally allowed to work in the United States?

YesNo
Have you ever pled "guilty" or "no contest" or been convicted of a crime?*

YesNo
If yes, give dates and details: Answering yes to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be considered.
Employment Desired:
Position Applying For*
Date You Can Start*

MonthDayYear
Salary Desired*
Have you ever worked for Apache Glass & Mirror?*

YesNo
How were you referred to us?
Are you over 18?

YesNo
Type of employment desired:
Education:
High School
Name of High School Attended
Number of Years Attended
Graduated?

Yes
College
Name of College/University Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Skills/Qualifications:
Summarize your special skills or qualifications here:
List any relevant skills
Current Employment:
Current Employer
Name of Current Employer or NONE if not Employed
Position
Responsibilities
Salary
Reason for Leaving?
Start Date

MonthDayYear
May We Contact?

YesNo
Previous Employment:
Previous Employer
Name of Previous Employer
Position
Responsibilities
Salary
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
Previous Employer
Name of Previous Employer
Position
Responsibilities
Salary
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
References:
Reference 1
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 2
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 3
Name of Reference
Relationship
Years Acquainted
Phone
Email
Cover Letter & Resume (Optional):
Cover Letter

Upload a File

Cancelof
Resume

Upload a File

Cancelof
Send Application:
By clicking the submit button below, I ceritify that all of the information provided by me on this application is true and complete to the best of my knowledge. I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected. In the even I am employed, I understand that false or misleading information given in my application of interview(s) may result in discharge.

I understand that my driving record will be checked. I consent to a drug test should I be selected for employment.

In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option.

I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.
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Employment Application

Personal Information:

Employment Desired:

Education:

Skills/Qualifications:

Current Employment:

Previous Employment:

References:

Cover Letter & Resume (Optional):

Send Application: