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Application for Employment

 Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran status.

 Date  ______________

Last name ________________________  First name ________________ Middle name________

Street Address _________________________________________________________________

City _____________________  State _______  ZIP _______

Điện thoại ___________________________ Social Security # ___________________________

 

Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.) q Yes  q No

Are you looking for full-time employment? q Yes   q No

If no, what hours are you available? ______________

Are you willing to work swing shift? q Yes   q No

Are you willing to work graveyard? q Yes   q No

Have you ever been convicted of a felony? (This will not necessarily affect your application.)

q Yes   q No

If yes, please describe conditions. _________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

 

Employment Desired

Position applied for __________________________________________

How did you hear of this opening? __________________________________________

Have you ever applied for employment here? q Yes   q No

When? ___________________________________ Where?___________________________________

Have you ever been employed by this company? q Yes   q No

When? ___________________________________ Where?___________________________________

Are you presently employed? q Yes   q No

May we contact your present employer? q Yes   q No

Are you available for full-time work?    q Yes   q No

Are you available for part-time work? q Yes   q No

Will you relocate?   q Yes   q No

Are you willing to travel? q Yes   q No   If yes, what percent? __________________________

Date you can start_______________________________________________________________

Desired position________________________________________________________________

Desired starting salary___________________________________________________________

Please list applicable skills________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

 

Education

                School Name and Location                                                                Year     Major          Degree

High School ________________________________________            ______ _________ ______

College ___________________________________________             ______ _________ ______

College ___________________________________________             ______ _________ ______

Post-College _______________________________________             ______ _________ ______

Other Training ______________________________________            ______ _________ ______

In addition to your work history, are there are other skills, qualifications, or experience that we should consider? ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Please list any scholastic honors received and offices held in school.

______________________________________________________________________________

______________________________________________________________________________

Are you planning to continue your studies?   q Yes   q No

If yes, where and what courses of study?

______________________________________________________________________________

Employment History           (Start with most recent employer)

Company Name ________________________________________________________________

Address ________________________________________Telephone ______________________

Date Started ____________  Starting Wage ____________  Starting Position _______________

Date Ended _____________  Ending Wage ____________  Ending Position ________________

Name of Supervisor ____________________________________

May we contact? q Yes   q No

Responsibilities ________________________________________________________________

______________________________________________________________________________

Reason for leaving ______________________________________________________________

 

Company Name ________________________________________________________________

Address _______________________________________ Telephone ______________________

Date Started ___________  Starting Wage ____________  Starting Position ________________

Date Ended _____________  Ending Wage ____________  Ending Position ________________

Name of Supervisor ____________________________________

May we contact? q Yes   q No

Responsibilities ________________________________________________________________

______________________________________________________________________________

Reason for leaving ______________________________________________________________

 

Company Name ________________________________________________________________

Address _______________________________________ Telephone ______________________

Date Started ___________  Starting Wage ____________  Starting Position ________________

Date Ended ___________  Ending Wage ____________  Ending Position __________________

Name of Supervisor ____________________________________

May we contact? q Yes   q No

Responsibilities ________________________________________________________________

______________________________________________________________________________

Reason for leaving _____________________________________________________________

 

Company Name _______________________________________________________________

Address _______________________________________ Telephone ______________________

Date Started ___________ Starting Wage ____________  Starting Position ________________

Date Ended ____________ Ending Wage ____________ Ending Position _________________

Name of Supervisor ____________________________________

May we contact? q Yes   q No

Responsibilities ________________________________________________________________

______________________________________________________________________________

Reason for leaving ______________________________________________________________

 

Company Name ________________________________________________________________

Address _______________________________________ Telephone ______________________

Date Started ___________  Starting Wage ____________  Starting Position ________________

Date Ended ____________  Ending Wage ____________  Ending Position _________________

Name of Supervisor ____________________________________

May we contact? q Yes   q No

Responsibilities ________________________________________________________________

______________________________________________________________________________

Reason for leaving ______________________________________________________________

 

Company Name ________________________________________________________________

Address _______________________________________ Telephone ______________________

Date Started ___________  Starting Wage ____________  Starting Position ________________

Date Ended ____________  Ending Wage ____________  Ending Position _________________

Name of Supervisor ____________________________________

May we contact? q Yes   q No

Responsibilities ________________________________________________________________

______________________________________________________________________________

Reason for leaving ______________________________________________________________

 

References

List three personal references, not related to you, who have known you for more than one year.

Name ____________________________ Phone ____________________Years Known_______

Address ______________________________________________________________________

Name ____________________________ Phone ____________________Years Known_______

Address ______________________________________________________________________

Name ____________________________ Phone ____________________Years Known_______

Address ______________________________________________________________________

 

Emergency Contact

In case of emergency, please notify:

Name ______________________________________________ Phone ____________________

Address ______________________________________________________________________

Name ________________________ Phone ____________________

Address ______________________________________________________________________

 

Please Read Before Signing:

I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.

I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees.

In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. I have received from the company a list of the approved documents that are required.

I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I hereby acknowledge that I have read and understand the above statements.

Signature _______________________________________________  Date_________________

 

 Thuviengiadinh.com (Theo Kinh tế) 

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