Application for Employment
Notice to All Applicants: Our Company is an Equal Opportunity
Employer and does not discriminate due to race, sex, religion, national origin, age, handicap or status as a disabled veteran
or veteran of the Vietnam era.
Date: ___________
Position Sought : ____________
Name (Last, First, MI, Name used): ___________________________________________
Soc. Security No. __________________ l8 or over? ____
Eligible to work in US? ____
Where can we contact you:? Address________________________________________
Phone__________ Best times? _________
How were you referred to us? ________
EDUCATION/TRAINING
| Name/location of school |
Courses studied |
GPA |
Graduated? |
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PHYSICAL/MENTAL/ATTENDANCE QUALIFICATIONS
Can you meet all requirements of the job applied for (including attendance
requirements), with or without reasonable accommodation? ____ If no, please describe requirements which you cannot meet:
______________________________________________________________
How will you get to work? ______________
How often were you absent from work during the past year? _________________
How often were you late for work? ___________________
EMPLOYMENT HISTORY (List all jobs held within the past 10 years, with
most recent job listed first. Use extra sheets if necessary)
| Company Name |
Positions Held |
Last Supervisor |
Final Payrate |
Reason for Leaving |
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| Address/Phone |
Experience Acquired: |
Machines Operated: |
Software Used: |
If laid off, will you accept recall? |
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| Company Name |
Positions Held |
Last Supervisor |
Final Payrate |
Reason for Leaving |
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| Address/Phone |
Experience Acquired: |
Machines Operated: |
Software Used: |
If laid off, will you accept recall? |
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| Company Name |
Positions Held |
Last Supervisor |
Final Payrate |
Reason for Leaving |
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| Address/Phone |
Experience Acquired: |
Machines Operated: |
Software Used: |
If laid off, will you accept recall? |
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Explanation for gaps: ______________________________________________
Other training or experience: ________________________________________
Are you claiming Veterans preference? _________ As disabled vet? ___(If
so, we will need proof of your service-connected disability). Please list date of discharge, type of discharge, and
highest rank ________________________________________________________
I certify that the above information is correct and truthful, and that falsification
of this application is grounds for rejection of the application or immediate discharge if I have been hired. I authorize you
to contact any prior employers, and release them and you from any liability arising from disclosure of information concerning
my past employment history. I understand that, as a condition of employment, I may be asked to pass a medical exam and that,
if employed, I will be employed "at will".
Applicant Signature _____________________
