Application for Employment

We consider applicants for all positions without regard to race, color, religion, gender, national origin, age, physical disability, marital or veteran status, or any other legally protected status.
Position(s) Desired:	Date:

How did you learn about us?

Advertising Friend Walk-in Employment Agency

FaceBook Relative Other

Personal Information?

First Name
Middle Name
Last Name
Street Address
City	State	Zip Code
Home Phone
Mobile Phone
Social Security Number
Email Address
List any friends or relatives currently working for our company.

Are you 18 years of age or older?	Yes No
Do you have reliable transportation?	Yes No
Have you ever been employed at any of our locations before?	Yes No
if yes, which site?
Are you currently employed?	Yes No
May we contact your present employer?	Yes No
Are you legally eligible for employment in the USA and this state?	Yes No
Are you willing to submit to a drug test?	Yes No
Have you ever been convicted of a felony? (Conviction will not necessarily disqualify an applicant from employment)	Yes No
if yes, Please explain the details of your conviction
Have you ever been terminated or asked to resign from any job?	Yes No
if yes, please explain?

Education?

High School Name & Address
Cours of Study
Years Completed
Dimploma/Degree

Undergrad College Name & Address
Cours of Study
Years Completed
Dimploma/Degree

Graduate Professional Name & Address
Cours of Study
Years Completed
Dimploma/Degree

Other(specify)
Cours of Study
Years Completed
Dimploma/Degree

Availability?

(Please provide days and hours that you are available to work)

Days	From:	To:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
On what date would you be available for work?
Do you prefer to work Full Time Part Time Either Temp

Employment Experiance

Start with your current or most recent job. Include any job-related military service assignment and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer	Dates Employed
Name & Address	From	To
Job Title Supervisor
Work Performed	Hourly Rate/Salary
	Starting	Final
Reason for Leaving

Employer	Dates Employed
Name & Address	From	To
Job Title Supervisor
Work Performed	Hourly Rate/Salary
	Starting	Final
Reason for Leaving

Employer	Dates Employed
Name & Address	From	To
Job Title Supervisor
Work Performed	Hourly Rate/Salary
	Starting	Final
Reason for Leaving

Employer	Dates Employed
Name & Address	From	To
Job Title Supervisor
Work Performed	Hourly Rate/Salary
	Starting	Final
Reason for Leaving

Employer	Dates Employed
Name & Address	From	To
Job Title Supervisor
Work Performed	Hourly Rate/Salary
	Starting	Final
Reason for Leaving

Pay rate desired

(Please list the salary range you are requesting)

References:

(Give name, address and phone number of three references who are not related to you )

Name and Address	Phone	Relationship & Years Known

Other Qualifications:

State any additional information you feel may be helpful to us in considering your application.

Applicant's Statement:

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 understand this application for employment shall be considered active for a period of time not to exceed 45 days. If I wish to be considered for employment beyond this time period, I should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge 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 document or by conduct unless such "at will" status is specifically changed 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.

Type your name in the Signature field below as your electronic signature.
Signature	Date
Validation Code:

If you would like to also send us a resume, references, or any other written documents for us to consider, please complete this web page application first, and then fax those documents to: (703) 766-6178