Employment Application 123456 Position Desired: When can you report? Salary Desired: Date of Application: PERSONAL INFORMATION This facility is an Equal Opportunity Employer.Last* First* Middle Initial Social Security Number: This is not a secure form.Home Phone*Street Address* Apartment #City* State* Zip* Work Phone Email Cell Phone Do you have relatives working for the company? No Yes If yes, list names: How were you referred to the company? Have you worked for the company before? No Yes Are you anticipating absences away from work of any duration? No Yes Explain: Are you available to work overtime, if necessary? No Yes Are you able to work weekends? No Yes Are you able to travel? No Yes Do you have reliable means of transportation to and from work? No Yes Explain: For driving jobs only: Do you have a drivers license? No Yes If yes, please provide license #, state and expiration date: If driving is a requirement of the position applied for, have you had your license suspended or revoked in the last 3 years? No Yes If yes, please explain: Availability to work: Full Time Part Time Temporary If part-time list the number of hours you can work per week: If temporary, available through? If necessary, are you able and available to work any of the following:Overtime?Overnight?HolidaysEvenings?Weekends?Business Travel? Type yes or no for each option.Can you present evidence of your U.S. citizenship or proof of your legal right to work in this country? No Yes If hired, proof of lawful right to work in the U.S. will be required.Are you 18 or older? No Yes If hired, can you show proof of age? No Yes EducationHigh SchoolHigh School NameLocationYears/Grade CompletedUnit CreditsGraduated? Completed?Major/Degree Earned Jr. CollegeJr College NameLocationYears/Grade CompletedUnit CreditsGraduated? Completed?Major/Degree Earned CollegeCollege NameLocationYears/Grade CompletedUnit CreditsGraduated? Completed?Major/Degree Earned Business or Trade SchoolBusiness Trade NameLocationYears/Grade CompletedUnit CreditsGraduated? Completed?Major/Degree Earned List professional designations: MilitaryHave you ever serviced in the United States Armed Forces? No Yes If yes, what branch? What was your final rank? Relevant Skills Acquired: SKILLED/ADDITIONAL INFORMATION List/check any of the following skills you possess.List any foreign languages you know: Can you read, write, or speak these languages? Read Write Speak Other applicable skills: Office (Word, Excel, Outlook) Windows Goldmine MAS 90 Oracle PeopleSoft PCC Check all those that apply.List any others here: Additional InformationHave you used any name other than the name you are currently using while attending school or with a previous employer? No Yes If yes, list name(s) you used below: As an employee, have you ever been involuntarily discharged or asked to resign? No Yes If required, will you undergo a pre-employment background check? No Yes If required, will you undergo a pre-employment physical or drug test? No Yes Are you able to safely perform the essential functions of the job which you are applying, either with or without reasonable accommodation? No Yes If no, if you require reasonable accommodation, please explain: Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform their essential job functions. An applicant's hire may be subject to passing a medical examination, skills and agility tests, etc. EMPLOYMENT HISTORY List all employment for the past 10 years, including military service and period of unemployment. For additional employment history or explanations, upload and attach a supplemental application for employment along with his application. You must complete this section even if you have a resume to upload.EMPLOYMENT #1Firm Please start with the most recent position.May we contact? No Yes Title and summary of your duties:Address City State Zip Supervisor PhoneDates of Employment Include month and year.Hours Full Time Part Time Reason for leaving: EMPLOYMENT #2Firm Please start with the most recent position.May we contact? No Yes Title and summary of your duties:Address City State Zip Supervisor PhoneDates of Employment Include month and year.Hours Full Time Part Time Reason for leaving: EMPLOYMENT #3Firm Please start with the most recent position.May we contact? No Yes Title and summary of your duties:Address City State Zip Supervisor PhoneDates of Employment Include month and year.Hours Full Time Part Time Reason for leaving: PROFESSIONAL REFERENCES In the spaces below, list three people not related to you who have knowledge of your work performance within the last three years.Reference 1:NameOccupation/How do you know this person?Phone NumberEmailYears Known Reference 2:NameOccupation/How do you know this person?Phone NumberEmailYears Known Reference 3:NameOccupation/How do you know this person?Phone NumberEmailYears Known AffidavitPut your initials under each section.I certify that all the information provided in this employment application and supplementary application are true and complete. I agree to have any of the statements checked by the Company unless indicated to the contrary. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. Initial aboveI am aware that a more detailed investigation concerning background and credit may also be conducted upon a contingent offer of employment, I hereby authorize that investigation. I also understand that employment is contingent upon satisfactory completion of reference checks and the provision of satisfactory proof of an applicant's identity and legal authority to work in the United States. Initial aboveI understand that if I am extended an offer of employment, it may be conditioned upon my successfully passing a pre-employment alcohol and drug screening examination. I understand that my job offer or my continuing employment, if hired, is contingent upon my being physically, mentally and medically able, with or without reasonable accommodation, to successfully perform the essential functions of my job. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. Initial aboveI understand that nothing in this application, conveyed during any interview, or subsequent employment creates a contract of employment between the Company or any subsidiary or affiliate and myself, nor guarantees employment for any definite period of time. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without cause or notice by either myself or the Company. I. understand that the Company can change benefits, policies and conditions at any time. Initial above.I understand that any and all disputes regarding my employment with the Company, including any disputes relating to the termination of my employment, are subject to the Alternative Dispute Resolution process, which includes final and binding arbitration. I also understand and agree, as a condition of employment, to submit any such disputes for resolution under that process, and I further agree to abide by and accept the decision of the arbitration panel as the final binding decision and resolution of any such disputes I may have. Initial aboveI understand that the Company may be required to participate in E-Verify. If so, the Company will provide the federal government with my Form I-9 information to confirm that I am authorized to work in the U.S. If E-Verify cannot confirm that I am authorized to work, the Company is required to give me written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so I can begin to resolve the issue before the Company can take any action against me, including terminating my employment. The Company can only use E-Verify once I have accepted a job offer and completed the Form I-9. Initial abovePlease read each statement above carefully before signing your name below.I have read, understand, and by my signature (typed below counts as my legal signature) consent to these statements. Applicant's Signature By typing your name above that counts as your legal signature.Date: ResumeAccepted file types: pdf, doc, docx, Max. file size: 64 MB.Please attach your resume here.