Application for Employment

Page 1

Position Applied For

How did you learn about us?

If Other, Please Specify:

Resume

Cover Letter

First Name

Middle Name

Last Name

Street

City

State Abbreviation

Zip Code

Email

Phone

Record Type Name

High School

Name

Address

Number of Years Completed

Diploma/Certificate

Undergraduate College

Name

Address

Course of Study

Number of Years Completed

Degree

Graduate Professional

Name

Address

Course of Study

Number of Years Completed

Degree

Other (specify)

Name

Address

Course of Study

Number of Years Completed

Certificate/Diploma/Degree

Describe any specialized training, apprenticeship, skills, and extra-curricular activities.

Describe any job-related training received in the United States military.

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. (You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities, or other protected status.)

If more than 4, please include in an attached resume.

Employer 1

Employer

Job TItle

Address

Phone

Supervisor

Reason for Leaving

Dates Employed

From

To

Work Performed

Employer 2

Employer

Job TItle

Address

Phone

Supervisor

Reason for Leaving

Dates Employed

From

To

Work Performed

Employer 3

Employer

Job TItle

Address

Phone

Supervisor

Reason for Leaving

Dates Employed

From

To

Work Performed

Employer 4

Employer

Job TItle

Address

Phone

Supervisor

Reason for Leaving

Dates Employed

From

To

Work Performed

Other Qualifications

List professional, trade, business or civic activities and offices held.

You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disabilities or other protected status.

Summarize special job-related skills and qualifications acquired from employment or other experience.

State any additional information you feel may be helpful to us in considering your application.

Page 5

References

1

Name

Relationship

PersonalProfessional

Phone

Email

2

Name

Relationship

PersonalProfessional

Phone

Email

3

Name

Relationship

PersonalProfessional

Phone

Email

Page 6

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall remain on file for one year from the submission date. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether applications are being accepted at that time.

I understand and acknowledge that, except as otherwise provided by an applicable collective bargaining agreement or by applicable law, employment is on an “at-will” basis. This means that either the Employee or the Employer may terminate the employment relationship at any time, with or without notice and with or without cause.

This at-will employment relationship applies only to employees who are not covered by a collective bargaining agreement that provides otherwise. Employees whose employment is governed by a collective bargaining agreement are subject to the terms and conditions of that agreement, including any provisions regarding discipline, discharge, grievance, arbitration, or other employment rights.

No supervisor, manager, or representative of the Employer has the authority to enter into any agreement that alters the at-will employment relationship for employees not covered by a collective bargaining agreement, except through a written agreement that is expressly approved and signed by an authorized executive of the Employer.

In the event of employment, I understand that false or misleading information given in my application or interviews(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Type Full Name

Date