Employee Application

First Name

Middle Name

Last Name

Address

Phone Number​

Email

Are you over the age of 18?

Please provide the required field.

If yes, Date of Birth?

If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States?

Please provide the required field.

Have you been convicted of a felony or been incarcerated in connection with a felony in the past seven years?

Please provide the required field.

If yes, please explain.

Position Applied For

How did you hear about this position?

Expected Hourly Rate

Expected Weekly Earnings

Date Available

If hired, on what date can you start working?

Can you work on the weekends?

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Can you work evenings?

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Are you available to work overtime?

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Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable accommodation?

Please provide the required field.

If no, describe the functions that cannot be performed

School Name

School Address

Last Year Complete

Number of years completed

Did you graduate?

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Degree / diploma earned

School Address

School Name

Last Year Complete

Number of years completed

Did you graduate?

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Degree / Diploma Earned

Are you currently employed?

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Are you currently employed?

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If you are currently employed, may we contact your current employer?

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Name of Employer

Name of Supervisor

Telephone Number

Business Type

Address

Length of Employment (Include Dates)

Position & Duties

Reason for Leaving

Previous Positions:​​​ Include for each employer/position from the past years:

Name of Employer

Name of Supervisor

Telephone Number

Business Type

Address

Length of Employment (Include Dates)

Position & Duties

Reason for Leaving

May we contact this employer for references?

Please provide the required field.

Name of Employer

Name of Supervisor

Telephone Number

Business Type

Address

Length of Employment (Include Dates)

Position & Duties

Reason for Leaving

May we contact this employer for references?

Please provide the required field.

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

Signature

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Date

Name

Email

Address

Phone

Business Name

Referral Bonus

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