Employment Application

Employment Application

The Mitographers, Inc. is an equal opportunity employer. Applicants will be considered regardless of race, color, national origin, religion, gender, age, marital, or veteran status; medical condition, disability; or any other legally protected status. Equal access to the hiring process, services, and employment is available to all individuals. Applicants requiring accommodations to the application and/or interview process should contact the Human Resource Representative.

Each question should be answered completely and accurately.

No action will be taken on this application until all questions have been answered and the application has been signed and dated. Verification of eligibility to work in the U.S. will be required if an employment offer is made.

Full Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

E-mail *

Confirmation Email

Position(s) applying for *

Wage expectations *

Salary or Hourly? *

Referral source

Are you over the age of 18? *

YES NO

Are you eligible to work in the United States? *

YES NO

Are you fluent in a foreign language? *

YES NO

If yes, what language(s)? *

Are you currently employed? *

YES NO

Date available for work *

Month Day Year

Are you available to work? *

Full time Part time Shift work Temporary

Have you applied here before? *

YES NO

If yes, give date: *

Have you been convicted of a felony/misdemeanor (other than traffic violations)? *

YES NO

If so, provide the location, date and result/outcome for each conviction: *

EDUCATION

Highest level of education completed: *

Please complete the appropriate sections

	Name & Location of School	Number of Years Attended	Did You Graduate?	Degree or Certification
GED / High School
Trade School
College
Graduate

WORK HISTORY

Please list your four most recent employers, list the most recent first

1. Employer

Employer's Name (Most current) *

Address & location of business *

Your title *

May we contact this employer? *

YES NO

Supervisor's name *

First and Last Name

Phone number *

Area Code Phone Number

Start date *

Month Day Year

End date

Month Day Year

Wages START: *

Salary or Hourly *

Wages END: *

Salary or Hourly *

Work performed: *

Reason for leaving *

2. Employer

Employer's Name (Second most recent) *

Address & location of business *

Your title *

May we contact this employer? *

YES NO

Supervisor's name *

First and Last Name

Phone number *

Area Code Phone Number

Start date *

Month Day Year

End date

Month Day Year

Wages START: *

Salary or Hourly *

Wages END: *

Salary or Hourly *

Work performed: *

Reason for leaving *

3. Employer

Employer's Name (Third most recent)

Address & location of business

Your title

May we contact this employer?

YES NO

Supervisor's name

First and Last Name

Phone number

Area Code Phone Number

Start date

Month Day Year

End date

Month Day Year

Wages START:

Salary or Hourly

Wages END:

Salary or Hourly

Work performed:

Reason for leaving

4. Employer

Employer's Name (Fourth most recent)

Address & location of business

Your title

May we contact this employer?

YES NO

Supervisor's name

First and Last Name

Phone number

Area Code Phone Number

Start date

Month Day Year

End date

Month Day Year

Wages START:

Salary or Hourly

Wages END:

Salary or Hourly

Work performed:

Reason for leaving

ADDITIONAL INFORMATION

Do you have a U.S. military service record? *

YES NO

Click to edit

If yes, branch of service *

Discharge date and rank *

List job-related accomplishments, projects, and awards. (Exclude information that would reveal race, color, national origin, religion, gender, age, marital, or veteran status; medical condition, disability; or any other legally protected status.)

List any additional information you would like us to consider:

REFERENCES

List three professional references, (business or work, not relatives) that you have known for at least one year. List at least one previous supervisor.

1. Full Name *

First Name Last Name

Company *

Best phone number to reach them *

Area Code Phone Number

Years acquainted *

Relationship *

2. Full Name *

First Name Last Name

Company *

Best phone number to reach them *

Area Code Phone Number

Years acquainted *

Relationship *

3. Full Name *

First Name Last Name

Company *

Best phone number to reach them *

Area Code Phone Number

Years acquainted *

Relationship *

AUTHORIZATION

I understand that The Mitographers, Inc. is making no employment offer at this time. I certify that the information in this application is correct to the best of my knowledge. I understand that any misrepresentation or omission of any fact in my application, resume, or any other materials, or during interviews is grounds for disqualification from further consideration for employment or for termination, if employed.

I authorize The Mitographers, Inc. to contact any company, institution, or individual it deems appropriate to investigate my employment history, character, qualifications, credit history, driving record, and other relevant information, if job-related. I give my full consent for all contacted individuals, including former employers, to provide information concerning this application, and I waive my right to bring any cause of action against these individuals for any and all liability for damages arising from furnishing the requested information to The Mitographers, Inc. I acknowledge that a facsimile and/or photocopy of this form is as valid as the original.

Pre-employment testing may be required (drug testing, background checks, physical examinations, motor vehicle checks).Testing may be applicant or employer paid based on the employer.I understand that any offer of employment may be withdrawn if drug tests are positive and/or if a condition is discovered for which no reasonable accommodation can be made.

I understand that this application is current for 60 days. At the conclusion of this time, if I have not heard from The Mitoraphers, Inc. and still wish to be considered for employment, it will be necessary to complete a new application.

I understand that if hired, employment is at-will, regardless of the employer, and may be terminated by myself or The Mitographers, Inc. at any time, with or without cause or notice, for any reason or no reason.

By entering your name, you agree to accept the terms of the above document with an electronic signature. *

I agree I do not agree

You must agree to accept the terms of the document in order to submit an application.

Type signature *

Date *

Month Day Year

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