Application for EmploymentName *Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryPhone *Email *Position(s) applied for: *Referral Source EmployeeAdvertisementInternetSchoolJob FairOtherBest time to call you is? 010203040506070809101112HH000510152025303540455055MMAMPMAM/PMMay we contact you at work? YesNoIf you are under 18 and it is required, can you furnish a work permit? YesNoHave you submitted an application here before? *YesNoHave you ever been employed here before? Yes or No? *Are you legally eligbile for employment in this country? *YesNoDate available for work? *What is your desired salary range or hourly rate of pay? Type of employment desired? *Full-TimePart-TimeEducation Co-OpSeasonalTemporaryWill you relocate if job requires it? YesNoWill you travel if job requires it? YesNoIf they have been explained to you, are you able to meet the attendance requirements of the position? YesNoN/AWill you work overtime if required? Yes or no? If no, please explain: Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodation? *YesNoNeed more informationHave you ever been bonded? *YesNoHave you ever pleaded guilty or no contest to or been convicted of a crime? Yes or no? If yes, please provide date(s) and details. *Have you entered into an agreement with any former employer or other party, such as a noncompetition agreement, that might, in any way, restrict your ability to work for our company? Yes or no? If yes, please explain. Employment History: in the space provided please list your most recent employers, and include their employer name, telephone number, address, job title, immediate supervisor and title, reason(s) for leaving, duties, dates, and salary or wages. *Explain any gaps in your employment, other than those due to personal illness, injury or disability. If not addressed already, have you ever been fired or asked to resign from a job? Yes or no? If yes, please explain. *Skills: Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying. Computer Skills: check appropriate boxes. Word ProcessingSpreadsheetsPresentationE-mailInternetOtherEducational Background: starting with your most recent school attended, provide the school name, years completed, degree/diploma/certification/GED/other, GPA, and your major or minor in the space provided. *References: list names and telephone numbers of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you. *To what job-related organizations - professional, trade, etc. - do you belong? List special accomplishments, publications, awards, etc. In your current job, have you ever written instructions or directions to be followed by employees or customers? Yes, no, or not applicable? If yes, please explain. Is there any other job-related information you want us to know about you? Upload resume and/or cover letter here. Applicant Statement I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable, local, state or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and the federal immigration laws require me to complete an I-9 Form in this regard. This company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status. Examples of prohibited harassment include, but are not limited to, unwelcome physical contact, offensive gestures, unwelcome comments, jokes, epithets, threats, insults, name-calling, negative stereotyping, possession or display of derogatory pictures or other graphic materials, and any other words or conduct that demean, stigmatize, intimidate, or single out a person because of his/her membership in a protected category. Harassment of our employees is strictly prohibited, whether it is committed by a manager, coworker, subordinate, or non-employee (such as a vendor or customer). The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.I, the applicant, agree to the truthfulness of the information provided in this application. Sign below: *I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. *I agreeDate * VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
