Application for Employment
(PLEASE PRINT)
Position Applied for
Date of Application
How did you learn about us?
Advertisement
Relative _______________
Employment Agency
Internet Site ______________
Walk-In
Other
________________
Friend
Last Name
First Name
Street Address
City
Telephone Number(s)
Cell
Other
If you are under 18 years of age, can you provide required
proof of your eligibility to work?
Yes
No
Have you ever filed an application with us before?
Yes
No
If Yes, give date: ____________________________
Have you ever been employed with us before?
Yes
No
If
Yes, give date: ____________________________
Yes
No
Yes
No
Yes No
Are you currently employed?
May we contact your present employer?
If No, when? ___________________________
Are you authorized to work lawfully in the United
States?
Will you now or in the future require Woods Cross City to
commence (“sponsor”) an immigration case in order to
employ you (for example, H-1B or other employment-
based immigration case)? This is sometimes called
sponsorship” for an employment-based visa status.
Y
es No
Proof of citizenship or immigration status will be required upon employment.
On what date wo
uld you be available to work? __________________________
Are you available to work:
Full Time
Part Time
Shift Work
Temporary
Are you currently onlay-off” status and subject to recall?
Yes
No
Can you travel if the job requires?
Yes
No
Have you ever been involuntarily terminated from a job?
Yes
No
If Yes, please explain
We consider applicants for all positions without discrimination based on race, color, religion, creed, gender, national origin, age, marital
or
veteran status, disability, or any other legally protected status.
WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER
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EDUCATION
Name and Address of
School
Course of Study
Diploma/Degree Level
High School
Undergraduate
College
Graduate Professional
Other (Specify)
Speak, Read and Write Fluently:
English Other: ____________________________________________
Describe any specialized training, apprenticeship, skills and extra-curricular activities.
Describe any job-related training received in the United States military.
EMPLOYMENT
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations
which indicate race, color, religion, gender, national origin, disabilities, or other protected status.
1. Employer
Address
Telephone Number(s)
Job Title
Reason for Leaving
2. Employer
Address
Telephone Number(s)
Job Title
Reason for Leaving
From To
WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER
© ThinkHR
3. Employer
Address
Telephone Number(s)
Job Title
Reason for Leaving
4. Employer
Address
Telephone Number(s)
Job Title
Reason for Leaving
From
To
If you need additional space, please continue on a separate sheet of paper.
ADDITIONAL INFORMATION
List professional, trade, business, or civic activities and offices held. You may exclude memberships which would reveal gender, race,
religion, national origin, age, ancestry, disability, or other
protected status:
Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.
WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER
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APPLICANT’S STATEMENT
FOR PERSONNEL DEPARTMENT USE ONLY
Arrange Interview? Yes No
Remarks: _________________________________________________________________________________________________
______________________________________ ____________________________________
INTERVIEWER DATE
Employed? Yes No Date of Employment: ___________________________________
Jo
b Title: __________________________ Hourly Rate/Salary _______________ Department ____________________
Notes:
I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an
employment decision.
I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT, IF HIRED, MY EMPLOYMENT RELATIONSHIP WITH THIS ORGANIZATION
WOULD BE OF ANAT WILLNATURE, WHICH MEANS THAT THE EMPLOYEE MAY RESIGN AT ANY TIME AND THE EMPLOYER
MAY DISCHARGE THE EMPLOYEE AT ANY TIME AND FOR ANY OR NO REASON. IT IS FURTHER UNDERSTOOD THAT THIS AT
WILL” EMPLOYMENT RELATIONSHIP MAY NOT BE CHANGED BY ANY WRITTEN DOCUMENT OR 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 application or interview(s) may
result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Signature of Applicant
Date
WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER
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