WWW.ASA.EDU
APPLICATION FOR EMPLOYMENT
NOTICE TO APPLICANTS
Federal and State law requires that all applicants be considered without regard to race, religion, color, sex, age
or national origin. We believe in and fully support the principle of equal employment opportunity and fulfill
our obligation to the fullest
Name
Address
Telephone Numbers
Position Applied For
Date you can start
Salary Expected
Hourly
Yearly
Full Time
How did you hear of opening?
Have you worked with us before?
Yes No
If Yes, please explain listing previous Job/Title/Location and Length of service:
What was your reason for leaving?
List any friends and/or relatives working with us now:
Do you speak any foreign language fluently?
Yes No
If Yes, please list
GENERAL INFORMATION
Are you under age 18: Yes No
If yes, please provide your age:
If you are under age 18, can you supply working papers?
Yes No
Only U.S. Citizens or legal aliens with work authorization are eligible for employment.
Can you, upon employment, provide genuine documentation establishing your identity
and eligibility to be legally employed in the United States?
Yes No
Have you ever trained in the Unites States military?
Yes No
If Yes, please give date:
Are you able to perform the essential requirements of the job? Yes No
If No, are there reasonable accommodations that can be made to allow you to perform the essential
functions of the job?
List professional, trade, business, or civil activities and offices held.
(You may exclude memberships which may reveal sex, race, religion, national origin, age or disability
or other protected status)
PERSONAL INFORMATION
Page 1
FTE (up to 78 hours biweekly)
PT (up to 56 hours biweekly)
:
:
REFERENCES
Give name, address, and telephone number of three business references who are not related to you.
1.
2.
3.
NAME AND LOCATION OF SCHOOL
GRADUATED
MAJOR/DEGREE
GPA
High School
Yes No
College
Yes No
Graduate School
Yes No
Other
Yes No
PRESENT/PREVIOUS EMPLOYEE DATA
LIST IN REVERSE ORDER BEGINNING WITH CURRENT EMPLOYER
1 –Company name
2 – Company Address
3 – City, State and Zip
4 – Contact / Phone No.
Position/ Job title
Dates
Reason for leaving
From
To
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Signature of Applicant
Date
I certify that the answers given above are true and complete to the best of my knowledge. I also authorize investi-
gation of all statements contained in this application for employment as may be necessary in arriving at an employ-
ment decision. I understand and acknowledge hereby that, unless otherwise defined by applicable law, any
employment relationship with this organization is of an “at will” nature, which means that the Employee may
resign at any time and the Employer may discharge Employee at any time with or without cause.
It is further understood that this “at will” employment relationship may not be changed by any written documen-
tation or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this
organization. In the event of employment, I understand that false or misleading information given in my applica-
tion or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules of the
Employer.
EDUCATION
EMPLOYMENT HISTORY
Page 2
Non scholae, sed vitae discimus!
click to sign
signature
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