Application For Employment {HR-722}

APPLICATION FOR EMPLOYMENT It is our policy to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental handicap, or veteran status. Name: Last First Middle Date Street Address City State Zip Telephone ( ) Social Security # Position applied for How did you hear of this opening When can you start Desired Wage $ Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? [ ] Yes [ ] No Are you looking for full time employment? [ ] Yes [ ] No If no, what hours are you available? Are you willing to work swing shift? [ ] Yes [ ] No Are you willing to work graveyard? [ ] Yes [ ] No Have you ever been convicted of a felony? [ ] Yes [ ] No If yes, please fully describe the circumstances: Education: School Name and Location Year Major Degree High School College College Other In addition to your work history, are there are other skills, qualifications, or experience we should consider: Employment History: (Start with most recent employer.) Company name Address Telephone Date Started Starting Wage Starting Position Date Ended Ending Wage Ending Position Name of Supervisor May we contact? [ ] Yes [ ] No Responsibilities Reason for leaving Company name Address Telephone Date Started Starting Wage Starting Position Date Ended Ending Wage Ending Position Name of Supervisor May we contact? [ ] Yes [ ] No Responsibilities Reason for leaving Company name Address Telephone Date Started Starting Wage Starting Position Date Ended Ending Wage Ending Position Name of Supervisor May we contact? [ ] Yes [ ] No Responsibilities Reason for leaving Attach additional information if necessary. I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history. I understand that employment at this company is "at will," which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment will continue on that basis. I understand that no supervisor, manager, or executive of this company, other than the president has the authority to alter the foregoing. Signature Date American LegalNet, Inc. 251 www.FormsWorkFlow.com