Application for employment.

PERSONAL:
Last Name First Name Middle Date
//
MM        DD        YYYY
Street Address Home Phone
()-
City, State, Zip Cell Phone
()-
HAVE YOU EVER APPLIED FOR EMPLOYMENT WITH US? YESNO
IF YES, WHEN? //
POSITION DESIRED
PAY EXPECTED
ARE YOU AVAILABLE FOR FULL TIME WORK? YESNO
WILL YOU WORK OVERTIME? YESNO
IF NOT, WHAT HOURS CAN YOU WORK?
ARE YOU LEGALLY ELIGIBLE FOR EMPLOYMENT IN THE UNITED STATES? YESNO
WHEN CAN YOU START? //
BIRTHDAY //

EDUCATION
SCHOOL NAME AND LOCATION OF SCHOOL COURSE
OF STUDY
YEARS
COMPLETED
DID YOU
GRADUATE

GRADUATE
YESNO

COLLEGE
YESNO

BUSINESS/
TRADE
YESNO

HIGH SCHOOL
YESNO
EMPLOYMENT:  PLEASE GIVE ACCURATE, COMPLETE FULL-TIME EMPLOYMENT RECORD.  START WITH YOUR PRESENT OR MOST RECENT
COMPANY NAME TELEPHONE
()-
ADDRESS EMPLOYED (State Mo. & Year)
FROM: /
MM
      YY
TO: /
MM        YY
NAME OF SUPERVISOR WEEKLY PAY
START LAST
STATE JOB TITLE AND DESCRIBE YOUR WORK REASON FOR LEAVING

COMPANY NAME TELEPHONE
()-
ADDRESS EMPLOYED (State Mo. & Year)
FROM: /
MM
      YY
TO: /
MM        YY
NAME OF SUPERVISOR WEEKLY PAY
START LAST
STATE JOB TITLE AND DESCRIBE YOUR WORK REASON FOR LEAVING

COMPANY NAME TELEPHONE
()-
ADDRESS EMPLOYED (State Mo. & Year)
FROM: /
MM
      YY
TO: /
MM        YY
NAME OF SUPERVISOR WEEKLY PAY
START LAST
STATE JOB TITLE AND DESCRIBE YOUR WORK REASON FOR LEAVING

WE MAY CONTACT THE EMPLOYERS LISTED ABOVE UNLESS YOU INDICATE THOSE YOU DO NOT WANT US TO CONTACT.
EMPLOYER REASON
PROSPECTIVE EMPLOYEES WILL RECEIVE CONSIDERATION WITHOUT DISCRIMINATION BECAUSE OF RACE, CREED, COLOR, SEX, AGE NATIONAL ORIGIN, HANDICAP OR ANY OTHER STATUS.
MARITAL STATUS NUMBER OF DEPENDENTS INCLUDING YOURSELF.
HOW LONG AT PRESENT ADDRESS? SEX
YEARS MaleFemale
ARE YOU A U.S. CITIZEN? IF LESS THAN 2 YEARS, WHAT WAS YOUR PREVIOUS ADDRESS?
YESNO
HAVE YOU EVER BEEN BONDED? ARE YOU OVER 18 YEARS OF AGE?
YESNO YESNO
IF YES, WITH WHAT EMPLOYER?
HAVE YOU EVER BEEN CONVICTED OF A CRIME IN THE PAST TEN YEARS, WHICH HAS NOT BEEN ANNULLED, EXPUNGED OR SEALED BY A COURT?  IF YES, DESCRIBE IN FULL.
YESNO     
HAVE YOU EVER FILED A WORKERS COMPENSATION CLAIM?  IF YES, DESCRIBE IN FULL.
YESNO     
STATE NAMES OF RELATIVES AND/OR FRIENDS WORKING FOR US.
                           
THE INFORMATION PROVIDED IN THIS APPLICATION FOR EMPLOYMENT IS TRUE, CORRECT, AND COMPLETE.  IF EMPLOYED, ANY MISSTATEMENT OR OMISSION OF FACT ON THIS APPLICATION MAY RESULT IN MY DISMISSAL.

I UNDERSTAND THAT ACCEPTANCE OF ANY OFFER OF EMPLOYMENT DOES NOT CREATE A CONTRACTUAL OBLIGATION UPON THE EMPLOYER TO CONTINUE TO EMPLOY ME IN THE FUTURE.

I UNDERSTAND THAT I AM REQUIRED BY LAW TO SUBMIT TO RANDOM DRUG TEST AT ANY TIME MY EMPLOYER REQUESTS.

IF YOU DECIDE TO ENGAGE AN INVESTIGATIVE CONSUMER REPORTING AGENCY TO REPORT ON MY CREDIT AND PERSONAL HISTORY, I AUTHORIZE YOU TO DO SO.  IF A REPORT IS OBTAINED YOU MUST PROVIDE, AT MY REQUEST, THE NAME OF THE AGENCY SO I MAY OBTAIN FROM THEM THE NATURE AND SUBSTANCE OF THE INFORMATION CONTAINED IN THE REPORT.
 I AGREE