Job Application

APPLICATION FOR EMPLOYMENT (Pre-Employment Application, An Equal Opportunity Employer)

Name Today's Date

Present Address

Permanent Address

Present Phone Permanent Phone

Are you 18 years or older?YesNo If No, how old?

Are you prevented from lawfully becoming employed in this country due to Visa or immigration status?YesNo

EMPLOYMENT DESIRED

Position Date you can start

Are you employed now?YesNo If Yes, by whom?

Referred by

EDUCATION

High School: Name and location
Years Attended Graduate?

College: Name and location
Years Attended Graduate? Subjects Studied

Other: Name and location Other Information

GENERAL

Something About Yourself

WRITE DOWN THE BEST TIMES AVAILABLE FOR YOU TO WORK (deli hours: 7am-3am):
Sun

Mon

Tues

Wed

Thu

Fri

Sat

FORMER EMPLOYERS List below last three employers, starting with most recent

Job 1: From-To(date/month/year)
Employer Name
Address
Phone of Employer Salary
Position Reason For Leaving

Job 2: From-To(date/month/year)
Employer Name
Address
Phone of Employer Salary
Position Reason For Leaving

Job 3: From-To(date/month/year)
Employer Name
Address
Phone of Employer Salary
Position Reason For Leaving

REFERENCES Please give the name of one person not related to you, whom you have known at least one year

Name Phone

Business Years Acquainted

IN CASE OF EMERGENCY

Name Address

Phone

Have you ever been convicted of a felony?YesNo

If so, for what?

I certify that all the information submitted by me on this application is true and complete and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated with or without cause and with or without notice at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed with or without cause and with or without notice at any time by the company. I understand that no company representative, other than the president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the forgoing.

I agree that the above is true (please type your name)

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