Job Applications

EMPLOYMENT APPLICATION                       DATE  ___________

You must be at least 16 years of age or older.

You must be willing to work nights, weekends and holidays.

Dress code:  Black slacks, black shoes (no open toed shoes), white shirt with collar. 

YOUR NAME ___________________________________    TELEPHONE  NUMBER ____________________________

 

ADDRESS  ___________________________________     I AM SEEKING TEMPORARY WORK UNTIL ____________

 

_____________________________________________     I AM SEEKING A PERMANENT POSITION?    YES  OR  NO

 

SOCIAL SECURITY # __________________________     I AM WILLING TO WORK ALL HOLIDAYS?     YES  OR  NO

 

DO YOU HAVE ANY PHYSICAL CONDITIONS WHICH MAY LIMIT THE PERFORMANCE OF DUTIES IN THE

POSITION FOR WHICH YOU HAVE APPLIED?  IF YES, PLEASE EXPLAIN  ______________________________________

_________________________________________________________________________________________________________

 

IF NECESSARY FOR THE JOB CAN YOU:                                     WORK SHIFTS?  _________________________

WORK OVERTIME?  _________________________                        TRAVEL?  ______________________________

 

IF NECESSARY FOR THE JOB, ARE YOU AT LEAST      15        16        17        18        19        21        (PLEASE CIRCLE)

I WILL BE ABLE TO REPORT FOR WORK  ____  DAYS AFTER BEING NOTIFIED THAT I AM HIRED.

ARE THERE ANY DAYS OF THE WEEK YOU ARE NOT ABLE TO REPORT TO WORK?  ____________________________

 

EDUCATION      SCHOOL NAME/ADDRESS               GRADUATED             MAJOR SUBJECT          GPA

   High School

____________________________________________________________________________________________________________

  College/University

____________________________________________________________________________________________________________

  Other

____________________________________________________________________________________________________________

 

REFERENCES:  List two personal references who are not relatives or former supervisors.

   Name                                                    Address                                   Occupation                              Years Known

__________________________________________________________________________________________________________

 

__________________________________________________________________________________________________________

 

EMPLOYMENT:  List last employment first.  Include summer or temporary jobs. 

Please show dates and locations of self-employment or periods of unemployment.

DATES            EMPLOYER  NAME/ADDRESS               POSITION / DUTIES / SKILLS                 REASON FOR LEAVING

from

 

to________

Salary

start

 

end                    Supervisor

__________________________________________________________________________________________________________

from

 

to________

Salary

start 

 

end                    Supervisor

__________________________________________________________________________________________________________

from

 

to________

Salary

start

 

end                    Supervisor

__________________________________________________________________________________________________________

 

 

OTHER INFORMATION:

Subjects of special study or research work:________________________________________________________________________

 

__________________________________________________________________________________________________________

 

Special Training:  ___________________________________________________________________________________________

 

__________________________________________________________________________________________________________

 

Activities:  (Civic, Athletic, Etc.):  ______________________________________________________________________________

 

__________________________________________________________________________________________________________

 

Contact (in case of accident or illness)  Name_____________________________________________________________________

 

Address___________________________________________________________Daytime Phone____________________________

 

Information to the applicant:  As part of our procedure for processing your employment application,  your personal

and employment references may be checked.  If you have misrepresented or omitted any facts on this application, and

are subsequently hired,  you may be discharged from your job.  You may make a written request for information derived

from the checking of your references.

 

If necessary for employment in a specific position, you may be required to :  have a physical examination, to provide evidence of citizenship or

date of birth,  or to sign a conflict of interest agreement and abide by its terms.

 

I understand and agree to the information shown above:

 

Signature__________________________________________________________Date_____________________________________

 

 

EMPLOYER SECTION:______________________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

 

__________________________________________________________________________________________________________


__________________________________________________________________________________________________________

 



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