Your Full Name
Phone Number
Street Address
City, State, Zip
Will you work overtime if asked? YesNo
Are you available to work full time? YesNo
If not, what hours can you work:
When will you be available to begin work?
Other special training or skills (machine operations, etc.) (Required)
Who referred you to this company?
If employed and you are under 18, can you furnish a work permit? YesNo
Highest Grade Completed —Please choose an option—FreshmanSophomoreJuniorSenior
Vocational School
College —Please choose an option—1234
Please give accurate, complete employment records. Start with your most recent employer.
1. Dates Employed to: Company Address City, State, Zip Supervisor Phone Number Starting Rate Ending Rate Reason for leaving
2. Dates Employed to: Company Address City, State, Zip Supervisor Phone Number Starting Rate Ending Rate Reason for leaving
3. Dates Employed to: Company Address City, State, Zip Supervisor Phone Number Starting Rate Ending Rate Reason for leaving
If you are presently working, may we contact your employer? YesNo
Any previous work injuries that would preclude you from performing the job you are applying for? If so what and to what degree?
Have you ever been convicted of a felony? YesNo
If yes for what?
Relatives employed by this company:
Notify in case of emergency: Name, Address, Phone Number:
Have you worked for this company before? YesNo
If yes, dates worked
Whether I am hired by the hour, week, bi-weekly, monthly, or yearly, I understand and agree that I have no employment contract running to any particular date or time in the future. To determine my qualifications for employment, I authorize this company to conduct and investigation of my application. I understand that any materially false, misleading, or omission of information furnished by me on this application form or in connection with my application for employment may result in rejection of the application, or if employed by the Company, in termination of employment. If I terminate, I shall be entitled only for compensation earned until the last date of my services to this employer.
Signature- by typing your full name we may hold you accountable for the accuracy of the information above.
AThis section to be completed by this company only after applicant is hired. Information is to be used only for completing records and not for hiring purposes.
Sex: —Please choose an option—MaleFemale
Race
Marital Status: —Please choose an option—SingleMarried
Date to start employment
Shift
Department
Classification
Starting Rate of Pay
Comments