EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION

Applications are considered without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job-related medical condition or handicap.

Employment Application

PERSONAL INFORMATION:

EMPLOYMENT ELIGIBILITY:

To be employed by ______________________________, you must meet certain state and federal employment eligibility requirements. These include (but are not limitedto) United States citizenship or authorization to work in this country, and no felony convictions (forsome jobs). Please answer the following questions

Questions:

EDUCATION:

EMPLOYMENT/WORK EXPERIENCE: Start with your present or most recent position. Include - 2 -military service assignments and volunteer activities. Exclude organization names that indicate race,color, religion, sex or national origin.

Dates of Employment (Month/Year):

Dates of Employment (Month/Year)

MILITARY SERVICE:

(A copy of a report of separation from the Armed Services may be required)

BUSINESS REFERENCES:

Please provide individual and company names, position, addresses andphone numbers for 3 business references.

PERSONAL REFERENCES:

Please provide names, addresses, phone numbers, relationship andhow long known for 3 personal references.

LANGUAGE SKILLS:

LICENSING/CERTIFICATION:

If a license or certification is required or related to the position forwhich you are applying, complete the following

SPECIAL SKILLS:

I AUTHORIZE any of the persons or organizations referenced in this application to give you any andall information concerning my previous employment, education, or any other information they may have,personal or otherwise, with regard to any of the subjects covered by this application, and I release suchparties from all liability from any damages which may result from furnishing such information to you.

I CERTIFY that the above answers are true and complete to the best of my knowledge. I authorize_______________________, to investigate any statement contained in this application, and to obtaina credit report on me (and my company if this application is for reselling by a company) as necessaryto determine my qualifications. I understand that this application is not and is not intended to be anykind of contract or agreement. In the event of employment, I understand that any false or misleadinginformation given in my application, correspondence, discussions or interview may result in refusal tohire or immediate termination if hired. I understand also, that I am required to abide by all rules,regulations and policies of ______________________