GENERAL EMPLOYMENT APPLICATION
*Fields in yellow are required.
General
Name (First, M.I., Last)
Address
Address
City State ZIP
Home Phone
Work Phone Ext
E-mail Address
Position Desired
Type of Employment Temporary Part Time Full Time
Referred by
Pay Rate Desired
Are you currently employed? Yes No
Available to begin
Available to work overtime Yes No
Have you ever been bonded? Yes No
Prior felony conviction? Yes No (If Yes, describe in miscellaneous field.)
Education
Highest Level of Education
Last school attended
City State
Employment Record
Most recent/current employer
Company
Supervisor
Address
Address
City State Zip
Phone Ext
Position Held Pay Rate
Start Date End Date
Reason for leaving
May we contact this employer? Yes No
Prior Employer
Company
Supervisor
Address
Address
City State Zip
Phone Ext
Position Held Pay Rate
Start Date End Date
Reason for leaving
May we contact this employer? Yes No
Prior Employer
Company
Supervisor
Address
Address
City State Zip
Phone Ext
Position Held Pay Rate
Start Date End Date
Reason for leaving
May we contact this employer? Yes No
REFERENCES
Reference 1
Reference Name
How acquainted
Phone Ext
Reference 2
Reference Name
How acquainted
Phone Ext
Reference 3
Reference Name
How acquainted
Phone Ext
OTHER INFORMATION
Special Courses or Training
Miscellaneous

The information I have provided in the application for employment is true, correct, and complete. False, incomplete, or misrepresented information of any kind will be sufficient cause for my application to be rejected or, if discovered after I am employed, cause for immediate termination of my employment.

I authorize the employer to contact and obtain information about me from previous employers, educational institutions, and "references" I provided, and any other party necessary to verify the accuracy of information I disclosed in this application, a related employment resume, or a personal interview. To assist in the processing of my application, I waive all rights and claims I may otherwise have against the employer or its representatives, for seeking, and using information to evaluate my employment request and all other persons, corporations, or organizations that provide information for this purpose.

This application is not an employment agreement. If I accept an offer of employment, I understand the employer may terminate my employment at any time, with or without cause and without prior notice, unless required by law. I understand that no one, other then an executive officer of the employer, has authority to enter into any employment agreement with terms contrary to the foregoing and then only in writing signed by each officer.

I fully understand and accept all terms and conditions in the above statement.

(Please note that we are unable to accept and process any application without the acceptance of this agreement).

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