APPLICATION FOR EMPLOYMENT
(AN EQUAL OPPORTUNITY EMPLOYER)
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Date: __________________________________________ |
Social Security No.: _____________________________ |
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Name: _________________________________________ |
Telephone (include area code): ___________________ |
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Address: _______________________________________ |
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What type of work/position are you applying for? _______________________________________________________
What special qualifications do you have? ______________________________________________________________
What machines (office or production) can you operate? ________________________________________________
What software packages can you operate? ___________________________________________________________
Are you at least 18 years old? __ Yes __ No
Are you either a US. citizen or an alien authorized to work in the United States? __Yes __ No
SPECIAL PURPOSE QUESTIONS
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Do not answer any of the questions in this framed area unless the employer has checked the line proceeding the question, thereby indicating that the information is required for a bona fide occupational qualification, or dictated by National security laws, or is needed for other legally permissible reasons.
___ Have you been convicted of Misdemeanor or Felony withing the last 5 years? * __ Yes __ No If YES, please describe ____________________________________________________________
__ I understand that I may be required and I agree to take a pre-employment drug test __ Yes __ No __ I understand that I may be required and I agree to take random / for cause drug tests __ Yes __ No __ I am capable of lifting 50 lbs of weight from ground level to chest level __ Yes __ No
* You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied. |
MILITARY SERVICE RECORD
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Branch of Service _______________ |
Discharge Date _________________ |
Rank __________________________ |
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Present membership in National Guard or Reserves __________________ |
Date Obligation Ends ____________ |
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EDUCATION
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School |
Number of Years Attended |
Name of School & City |
Major |
Did you Graduate? |
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High |
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College |
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Other |
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EXPERIENCE
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Name & Address of Company |
Date From-To |
List of Duties |
Starting Pay |
Final Pay |
Reason for Leaving |
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