| Education |
| Are you presently a student? Yes No |
| If not currently attending, when do you plan to attend? |
| Type of School | Name | Location of School | Degree/Area of Study | Number Years Attended | Graduated (Check one) |
| High School | | | | 1 2 3 4 | Yes No |
| College | | | | 1 2 3 4 | Yes No |
| Other | | | | 1 2 3 4 | Yes No |
| Are you fluent in any other language other than English? Yes No | Which language? | | Written Verbal Both |
| WPM Typing Word Excel Other |
| Additional Inquires |
| Have you ever been dismissed or asked to resign from any employer? Yes No |
| If yes, please explain: |
| Have you been convicted of a crime in the last 7 years? Yes No | | If yes, please explain: A conviction will not necessarily disqualify you for employment. |
| Permission to Work |
| Are you legally eligible for employment in the U.S.? Yes No Proof of U.S. citizenship or immigration status will be required if hired for a position. |
| Referral Source |
| Walk in Applicant Employment Agency Newspaper (Name) Internet (Source) |
| School Employee Referral (Name) Other(Specify) |
| Additional Questions |
| Why are you interested in working for our company? |
| What strengths would you bring to our company? |
| What didn't you like about your previous jobs? |
| If hired, I agree to abide by the rules of the company. If hired,
I understand that my employment is at will. This means that I do not have a contract of employment
for any particular duration or limiting the grounds for my termination in any way. I am free to resign
at any time. Similarly, the company is free to terminate or change the terms and/or conditions
of employment at anytime for any reason or no reason at all. The only time my at will status or
anything contained herein could be changed is if I were to enter into a written contract with an
authorized representative (Human Resources Director, COO, or CEO) of the company explicitly promising
me job security. All of the information I have supplied in this application to the best of my
knowledge is true and complete statement of the facts, and if employed, any omissions or false or
misleading statement(s), on this application or during the interview process could result in immediate
dismissal regardless of when such information is discovered. I further authorize all courts, probation
departments, prosecutor's office, boards, employers, references, educational and credit companies,
consumer agencies, without exception, to furnish the company or its representatives any and all
information any of them have concerning me. I further authorize a check by any consumer agency of
my employment history as well as any incidents of employment dishonesty, retail theft, credit/bankruptcy,
or criminal activity. I understand that my employment and/or retention may be affected in whole or in part
from a report or any information either verbally or in writing received from this agency or any of the
above mentioned entities, companies, or persons. I hereby discharge and exonerate the company, its
agents and representatives, or any person entity so furnishing information or the investigation made
by the company. A Photostat copy or fax of this authorization will be considered as effective and
valid as the original. (Whenever legally required, a copy of any credit report and other information
will be available upon request.)I agree to protect the company's confidential information,
trade secrets and other proprietary information and will not reveal such information, which I am
informed (verbally or written) is confidential or which anyone could perceive is confidential to anyone
at anytime during or after cessation of my employment.I further understand that the company will
not employ persons who use illegal drugs or engage in substance abuse, and that the company retains the
right to screen from employment such individuals. |
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| By Checking this box, you agree that the information is true and correct. |
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