APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT
All applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical/mental disability, severe/morbid obesity, medical condition, military/veteran status, genetic information, marital status, ethnicity, alienage or any other protected classification, in accordance with applicable federal, state, and local laws. By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our customers and contributing to the financial success of the company, its clients, and its employees. Equal access to programs, services, and employment is available to all qualified persons. Those applicants requiring accommodation to complete the application and/or interview process should contact a management representative.
Position(s) Applied for
Date of Application

MonthDayYear
Full Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Social Security Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Cell/Alternate Number

Area CodePhone Number
EMPLOYMENT EXPERIENCE
Please list the names of your present or previous employers in chronological order with present or last employer listed first. Be sure to account for all periods of time. If self-employed, give firm name and supply business references.
Name of Employer
Supervisor
May we contact?

YesNo
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Dates Employed
From

MonthDayYear
To

MonthDayYear
Pay Rate
Starting
Final
Job Title and Duties
Reason for Leaving
Name of Employer
Supervisor
May we contact?

YesNo
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Dates Employed
From

MonthDayYear
To

MonthDayYear
Pay Rate
Starting
Final
Job Title and Duties
Reason for Leaving

Name of Employer
Supervisor
May we contact

YesNo
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Dates Employed
From

MonthDayYear
To

MonthDayYear
Pay Rate
Starting
Final
Job Title and Duties
Reason for Leaving
Have you ever been involuntarily terminated or asked to resign from any job?

YesNo
If yes, please explain
Please explain any gaps in your employment history
Please list any other experience, job related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualifications for employment.

Education

Please describe your educational background in the table provided below

	School Name	Years Completed	Diploma/Degree (Y/N)	Course of Study/Major	Specialized Training, Skills, Extracurricular Activities
High School
College/University
Graduate/Professional School
Trade School
Other

Business and Professional References

Please list three professional references of individuals who are not related to you.
Name and Title
Relationship
Phone Number

Area CodePhone Number
E-mail
Name and Title
Relationship
Phone Number

Area CodePhone Number
E-mail
Name and Title
Relationship
Phone Number

Area CodePhone Number
E-mail
Personal References

Please list three people who know you well.
Name and Title
Relationship and Years Acquainted
Phone Number

Area CodePhone Number
E-mail
Name and Title
Relationship and Years Acquainted
Phone Number

Area CodePhone Number
E-mail
Name and Title
Relationship and Years Acquainted
Phone Number

Area CodePhone Number
E-mail

APPLICANT STATEMENT AND AGREEMENT

Please read and initial each paragraph below. If there is anything that you do not understand, please ask.
I hereby authorize the Company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
In the event of my employment with the Company, I understand that I am required to comply with all rules and regulations of the Company.
If hired, I understand and agree that my employment with the Company is at-will, and that neither I, nor the Company is required to continue the employment relationship for any specific term. I further understand that the Company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.
I understand that safety of employees is extremely important to the Company and that the Company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.
I hereby certify that the 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.
I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard.
I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable.
MY ELECTRONIC SIGNATURE BELOW ATTESTS TO THE FACT THAT I HAVE READ, UNDERSTAND, AND AGREE TO ALL OF THE ABOVE TERMS.
Signature

Clear
Date

MonthDayYear
Name (print)
Should be Empty:

	Mon	Tue	Wed	Thu	Fri	Sat	Sun
Service Quality
Overall Hygiene
Responsiveness
Kindness and Helpfulness

APPLICATION FOR EMPLOYMENT

EMPLOYMENT EXPERIENCE

Education