EMPLOYMENT APPLICATION
VALID FOR 30 DAYS
Date: ______________________
GENERAL INFORMATION (Please Print with Black Ink)
Name: Last, First, Middle Initial
Social Security # (Voluntary)
Home Phone #
( )
Cell Phone #
( )
Email Address:
Are you 18 years of age or older?
Are you legally eligible for employment in the USA?
(If yes, verification will be required)
Yes
No
Yes
No
Position Desired
Wages Expected
Previously Employed Here?
CA Journeyman or Trainee Card & Exp Date
Yes
No
Date Available for Work: _______________ / _______________ / _______________
Type of Employment desired: Full Time Part Time Temporary Seasonal Educational Co-op
Do you have relatives or friends in our employ: Yes No (If yes, please list names)
Name: _________________________________________ Relationship: _____________________________
Name: _________________________________________ Relationship: _____________________________
Phone Number
( )
Address, include zip code
Are you willing to work overtime if necessary: Yes No
EDUCATION
Check Last Year Completed:
Describe any other training or education
Elementary
5
6
7
8
High School
1
2
3
4
College
1
2
3
4
EMPLOYMENT APPLICATION
VALID FOR 30 DAYS
EMPLOYMENT HISTORY (Last Employer First)
Dates
Employers Name
Kind of Work
Reason for Leaving
From
To
From
To
From
To
From
To
May we contact previous employers for reference: Yes No Later
If no, specify: _____________________________________________________________________________
Skills and Qualifications: Summarize special skills and qualifications acquired from employment and other
experiences that may qualify you for work with our Company.
It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for
cancellation of this application and/or termination if I have been employed. Furthermore, I understand that just
as I am free to resign at any time, the Company serves the right to terminate my employment at any time, with
or without cause and without prior notice. I understand that no representative of the Company has authority
to make assurances to the contrary.
I give the Company the right to investigate all references and to obtain job-related information about me. I
hereby release the Company and its representatives from liability as well as any persons, corporations or
organizations furnishing information.
The Company is an EQUAL OPPORTUNITY EMPLOYER and does not discriminate in employment. No
question on this application is used for the purpose of limiting or excluding any applicant's consideration for
employment on a basis prohibited by local, state, or federal law.
I agree that placement or continuing employment may be contingent upon the successful completion of a
MEDICAL EXAMINATION, which may include drug testing.
Signature of Applicant
Date
Do Not Write Below this Line
Accepted for Employment: Yes No Rate: ____________________ Date: ________________
Work Location: _____________________________________ Position: ______________________________
Signature
Title
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