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First Name*

Last Name*

Address*

Address 2

City*

State*

Zip*

Phone*

Are you legally entitled to work in the United States?*

Have you ever applied for a job with this company?*

Have you ever worked for the company before?*

The position you are applying for is:*

Salary expected per hour:*

Type of employment*

Full-time
Part-time
Temporary

Will you accept part-time employment?*

If yes, specify the days and hours you are available to work:

If your application is considered favorable, on what date can you start to work?*

Is your current age 16 years or older?*

18 years or older?*

Can you work shifts?*

If yes, what shifts can you work?*

First (Early Mornings)
Second (Afternoon-Evenings)
Nights

Can you work overtime?*

List any special skills or abilities related to the job applied for:*

Describe your greatest accomplishment from any previous position that you have held:*

Education

Elementary (No. of years attended)*

High School (No. of years attended)*

High School name:*

College (No. of years attended)

College name:

Graduate:

Employment Record

(Please list most recent position first)

Name and Address of Employer:*

Exact reason for leaving:*

Describe the type of work you did:*

Salary (from/to)*

Telephone:*

Supervisor:*

May we contact them?*

Employer #2:

Name and Address of Employer:

Exact reason for leaving:

Describe the type of work you did:

Salary (from/to)

Telephone:

Supervisor:

May we contact them?

Employer #3

Name and Address of Employer:

Exact reason for leaving:

Describe the type of work you did:

Salary (from/to)

Telephone:

Supervisor:

May we contact them?

Personal References

(not former employers or relatives)

Reference #1

Name and Occupation:*

Address:*

Telephone Number:*

Reference #2

Name and Occupation:*

Address:*

Telephone Number:*

Reference #3

Name and Occupation:*

Address:*

Telephone Number:*

Military Information

Have you served in the U.S. Armed Forces?*

Branch of service:

Total months of active duty:

Rank of induction:

Highest Rank Attained

Specialized military experience:

Security Information

Have you ever been convicted of a felony or misdemeanor or other than a minor traffic offense which has not been pardoned or expunged from your record? *

If yes, list date, city, charge or disposition:

(Conviction of a felony or misdemeanor will not automatically disqualify you from consideration of employment)

Read before submitting

This application will become inactive after 60 days. If you wish to be considered for employment, after that time, you must complete a new application for employment. All applications will, however, be retained in our files for a period of twelve months.

This company does not discriminate against qualified applicants or employees on the basis of race, creed, national origin, sex, ancestry, pregnancy, sex, color, age or other status or condition protected by applicable law. However, we insist that all of our employees can perform the essential functions of their employment and have the character, integrity, and general reputation of honesty of a person we would be willing to have represent our company in its dealings with our clients, affiliates, suppliers and/or other employees. Accordingly, we insist on complete honesty. ANY LATER DISCOVERY THAT AN APPLICANT WAS NOT HONEST IN COMPLETING THIS APPLICATION WILL BE GROUNDS FOR DISCHARGE.

ATTESTATION:

I authorize or instruct this company to make whatever inquiries it deems necessary (or any former employer, personal reference, or school official named in this application or referred by a person named in this application) in order to verify any information in my application and/or determine my qualifications and abilities and I agree to release and hold harmless those entities from any and all liability arising from the release of such information. I understand that such inquiries may include information as to my character, general reputation or personal characteristics. Statements I made on the application are true and complete. I understand that if, in the judgment of the Company, I have made any false statements, omissions, concealments, or misrepresentations or I have failed to answer any questions fully and accurately, or results of such investigation are not satisfactory, any offer made by the Company may be withdrawn or my employment with the Company be terminated immediately, without any obligation to me other than for payment at the rate agreed upon for services rendered after I have been employed. I agree to conform to the rules and regulations of the Company, and understand that, if I am hired, my employment and compensation can be terminated, with or without cause and with or without notice, at any time, at the option of either the to enter into any agreement for employment for any specific period of time unless such agreement is in writing and signed by the Company's designated representative.

I have read and agree to the terms of this application*

Date:*

Email*

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Application for Employment - Mount Vernon

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