Employment Application

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and background check. This application will remain active for 3 years.

NOTE: Not all application fields are required. Please fill out the application to to the best of your knowledge. If there is any information you do not know or is not relevant to you then you may leave it blank.



Current Address
Prior Address
Prior Address


High School
Undergrad School
Grad School
Other School


Employment Information
 Weekends  Evenings
 M  Tu  W  Th  F  Sa  Su
Please answer all of the following questions.
1) Are you at least 18 years of age and legally eligible to work for our company in the United States?
If you are under 18 years of age, can you provide required proof of your eligibility to work?
2) Have you worked for this business before?
If yes, please provide dates and locations.
3) Do you have your own transportation (do you own a vehicle)?
4) If hired, are you willing to submit to and pass a controlled substance test?
If no, please explain.
5) Are you on layoff and subject to recall?
6) Are you currently bound by a noncompetition, confidentiality or trade secret agreement?
If yes, please explain...
7) Have you ever been discharged or asked to resign from a job?
If yes, please explain...
8) Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?
If yes, please describe the nature of the crime, when and where convicted, and current status of the case.
9) Do any of your friends or relatives, other than spouse, work here?
If yes, state name and relationship...


Are you currently employed?
May we contact your present employer?
Most Recent Employer
Prior Employer
Prior Employer
Prior Employer


Job-related Skills




Resume (Text Version)
Copy and Paste a text version of your resume here.
Upload File
Attach a file to your application submission (Permitted File Types: doc,docx,pdf,txt - Max file size: 1045876 bytes)


Applicant Certification Agreement
1. I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true and correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from the company.
2. I understand that if I am hired, my employment is not definite and can be terminated at any time either with or without prior notice, and by either myself or the company.
3. I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I 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 examination or revelation.
Security Code
Security Code
Type Name in Signature Box*:
Date: 2021-01-27 20:18:15