Form S-4 – Page 1 of 6 © The Personnel Advisor 609
APPLICATION FOR EMPLOYMENT
An EQUAL OPPORTUNITY EMPLOYER
(PLEASE PRINT)
Date of Application
Position(s) Applied For
Name
Telephone
Last First Middle Area Code
Address
Number Street City State Zip Code
If employed and under 18 years of age, can you furnish a work permit?
Yes No
Have you filed an application with this company before
Yes No
If yes, give date:
Have you ever been employed with this company before?
Yes No
If yes, give date:
Are you currently employed?
Yes No
If yes, may we contact your present employer? Yes No
Are you prevented from lawfully becoming employed
in this country because of visa or immigration status?
(
Proof of citizenship or immigration status will be required upon employment.)
Yes No
On what date would you be available for work?
When are you available to work?
Full Time Part Time Shift Work Temporary
Have you been convicted of a felony within the last 7 years?*
(
Conviction will not necessarily disqualify applicant from employment.)
Yes No
If yes, please explain:
(*California applicants: Do not disclose sealed, erased, or expunged convictions, or marijuana-related
convictions that are more than two years old.)