Online Employment Application


1. Name and Current Address:

First Name:
Last Name:
Middile Initial:
Valid Email Address:
Position Applied For:
Salary Desired:
Street Address:
City:
State:
Zipcode:
Daytime Telephone:
Evening Telephone:

Are you employed now?
Yes No

If so, may we inquire of your present employer?
Yes No

Are you at least 18 years of age?
Yes No

Do you have any friends or relatives working with us?
Yes No

Have you ever applied for this company before?
Yes No

Are you applying for Full Time, Part Time or Temporary?

What prompted you to apply here?


2. If Hired:


Can you present evidence of U.S. Citizenship or proof of your legal right to live & work in this country?
Yes No

What days and hours are you available for work?

Are you available to work on weekends?
Yes No

Are you able to work overtime, if necessary?
Yes No

On what day can you start?

Work schedules may vary from week to week and occasionally employees are asked to stay late, leave early
or come in on a scheduled day off.

3. Personal References:

List two non-relatives you have known at least 1 year:

Reference 1
  
Name:
Telephone Number:
Relation:
Years Known:
Reference 2
  
Name:
Telephone Number:
Relation:
Years Known:


4. Education:

Highschool/College 1
 
School Attended:
Name at School:
How Many Years Completed:
Did You Graduate?
Yes No
Degree(s) and/or
Subjects Studied
Highschool/College 2
 
School Attended:
Name at School:
How Many Years Completed:
Did You Graduate?
Yes No
Degree(s) and/or
Subjects Studied


5. Special Questions:

What foreign language(s) do you speak fluently?


List past or present communicable illnesses (such as T.B., etc)


Do you have any objection to adhering to a company dress code? (hair length, clothes, etc)
Yes No


Have you been convicted of a felony within the past seven years?
Yes No


Can you perform all the essential duties of the position for which you are applying?
Yes No


How much weight can you lift?
30 lbs 50 lbs 70 lbs 90 lbs


6. Employment History:

Previous Employer 1
 
From (MM/YYYY):
To (MM/YYYY):
Employer's Name:
Complete Address:
Telephone:
Starting Pay:
Ending Pay:
Job Title:
Description of Duties:
Reason For Leaving:
May we contact?
Yes No
Previous Employer 2
  
From (MM/YYYY):
To (MM/YYYY):
Employer's Name:
Complete Address:
Telephone:
Starting Pay:
Ending Pay:
Job Title:
Description of Duties:
Reason For Leaving:
May we contact?
Yes No



Please read each paragraph below carefully, then check the corresponding acknowledgement boxes before submitting your employment application:
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and 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 any document used to secure employment shall be grounds for rejection of this application of for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I have read and agree with the above paragraph.


I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company's designated representative.
I have read and agree with the above paragraph.