Employment Application {HR-714}

- 1- Employment Application Personal Information Name (Last, First, MI) Street address City, State, Zip Last Name, First Initial: Home phone number Work phone number Fax number E-mail address Social security number Driver?s license number/state/expiration (if job involves any driving) Employment Desired Position applied for How did you hear about this position? Date available for work Desired hours (full time, part time, etc.) Desired Salary Education Name and Address of School Course of Study T otal Years of Study Degree/ Diploma High School Undergraduate College Graduate/ Professional Today?s Date: Other (Specify) List any seminars, classes or other education not listed above which may help qualify you for this position (if you need additional space, please use page 7): - 2- Employment Application Employment History List below all present and past employers over the past ten years, starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume. May we contact your current employer? YES NO Employer (current Yes No) Start Date End Date Essential job functions of final position Address 1. City, State, Zip Starting Salary Ending Salary 2. Phone number 3. Fax number Supervisor(s) 4. Job position(s) E-mail address of supervisor Reason(s) for leaving What value did you add to this company or its customers? 1. Employer Start Date End Date Essential job functions of final position 2. Address 1. City, State, Zip Starting Salary Ending Salary 2. Phone number 3. Fax number Supervisor(s) 4. Job position(s) E-mail address of supervisor Reason(s) for leaving What value did you add to this company or its customers? [PLEASE CONTINUE ON NEXT PAGE] - 3- Employment Application Employment History Employer Start Date End Date Essential job functions of final position Address 1. City, State, Zip Starting Salary Ending Salary 2. Phone number 3. Fax number Supervisor(s) 4. Job position(s) E-mail address of supervisor Reason(s) for leaving What value did you add to this company or its customers? 3. Employer Start Date End Date Essential job functions of final position 4. Address 1. City, State, Zip Starting Salary Ending Salary 2. Phone number 3. Fax number Supervisor(s) 4. Job position(s) E-mail address of supervisor Reason(s) for leaving What value did you add to this company or its customers? [PLEASE CONTINUE ON NEXT PAGE] - 4- Employment Application Employment History Employer Start Date End Date Essential job functions of final position Address 1. City, State, Zip Starting Salary Ending Salary 2. Phone number 3. Fax number Supervisor 4. Job position(s) E-mail address of supervisor Reason(s) for leaving What value did you add to this company or its customers? 5. Employer Start Date End Date Essential job functions of final position 6. Address 1. City, State, Zip Starting Salary Ending Salary 2. Phone number 3. Fax number Supervisor 4. Job position(s) E-mail address of supervisor Reason(s) for leaving What value did you add to this company or its customers? [PLEASE CONTINUE ON NEXT PAGE] - 5- Employment Application Additional Information List any professional, trade, business or civic activities and offices held. You may exclude membership that would reveal gender, race, religion, national origin, ancestry, age, disability or any other protected status. List any languages other than English that you can speak, read or write that could be of benefit to the position applied for: Fluent Good Fair Speak Read Write Identify formal job training that relates to this position: Identify what skills or certification you possess related to this position: If you are hired, what value would you add to our company?: Describe what you believe are the most unique features of your work history: - 6- Employment Application Additional Information Have you ever been employed with this company before? Yes No If Yes, when? Do you have any friends or relatives employed by this company? Yes No If Yes, please provide their names and relationship to you: Are you currently employed? Yes No May we contact your employer? Yes No Are you currently on ?lay off? status and subject to recall? Yes No If you are under 18 years of age, can you provide proof of your eligibility to work? Yes No If hired, can you provide proof of U.S. citizenship or proof of your legal right to work in the U.S.? Yes No Are you able to perform all of the essential functions of the job for which you are applying with or without reasonable accommodation? Yes No If hired, are there any accommodations the company would need to provide so that you can perform all those essential functions and duties of the position being applied for? Yes No If Yes, please explain: If driving is a requirement of the position applied for, have you in the last 7 years been convicted of Driving Under the Influence ?(DUI)? Yes No N/A If hired, do you have a reliable means of transportation to and from work? Yes No If hired, would you be able to travel or work overtime as needed? Yes No Have you ever been convicted of a felony or misdemeanor? Yes No If Yes, please explain: - 7- INSTRUCTIONS FOR ANSWERING APPLICATION QUESTION ABOUT BEING CONVICTED OF A CRIME OR OTHER STATE-SPECIFIC REQUIREMENTS A criminal record does not constitute an automatic bar to employment and will be considered only as it substantially relates to the job in question. If you are applying for a position with our company in the following states, please read the following instructions before responding. CA Do not provide information concerning: (1) any conviction for which the record has been judicially ordered sealed, expunged or statutorily eradicated. or:, (2) any misdemeanor conviction for which probation has been completed or discharged and the case has been judicially dismissed. References List below three persons not related to you who have knowledge of your work performance within the last 5 years Name Occupation Company name Address Telephone E-mail Relationship & years acquainted Name Occupation Company name Address Telephone E-mail Relationship & years acquainted Name Occupation Company name Address Telephone E-mail Relationship & years acquainted - 8- Additional Space Additional space provided to expand on any points or questions asked previously in this application PLEASE USE ADDITIONAL PAPER IF NECESSARY American LegalNet, Inc. © www.FormsWorkFlow.com