Name: Last, First & Middle Initial

Address:

Phone:

Email Address

Position Applied For:

Employment Desired (Full Time, Part Time, On-Call) Employment Desired (Full Time, Part Time, On-Call)Full TimePart TimeOn-Call

Your Educational Level: Your Educational Level:High School/GEDCollege/UniversityBusiness/Trade School

Please List Your Diplomas, Degrees or Certificates Achieved:

If you served in the United States Armed Forces, briefly describe the skills acquired:

Are you legally authorized to work in the U.S.? Are you legally authorized to work in the U.S.?Yes. Legally Authorized.No. Not Legally Authorized.

Are you at least 18 years of age? Are you at least 18 years of age?YesNo

Have you ever been charged/convicted of a crime? (A conviction does not automatically bar you from employment) Have you ever been charged/convicted of a crime? (A conviction does not automatically bar you from employment) YesNo

If YES, give details (number and nature of conviction(s), date(s) and type(s) of rehabilitation:

Do you have any skills you wish to mention?

Are you presently Employed? Are you presently Employed?YesNo

If so, may we contact your present employer? If so, may we contact your present employer?YesNo

If hired, when would you be available?

Salary Expectations:

Please Read and Check if you Agree and Understand: Please Read and Check if you Agree and Understand: I certify that the answers given by me to the foregoing questions and statements are true and correct without consequential omissions of any kind. I agree that the company shall not be held liable in any respect if my employment is terminated because of false statements, answers or omissions made by me in this application. I understand that any misleading or incorrect statements may render this application void, and if employed, may be cause for termination. I understand that a medical examination based on the requirements of the position for which I am being considered may be required, a drug testing may be included as part of the regular pre-employment physical. I also authorize the companies, schools or persons named above to give any information requested regarding my employment, character and qualifications. I hereby release said companies, schools or persons from all liability for any damage for issuing this information. In consideration of my employment, I agree to conform to the rules and regulations of this organization. My employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either my employer or myself.