Job descriptions and applications

The preparation of job descriptions and applications are important tasks for a Pennsylvania employer.  Missteps in either of these areas can subject an employer to legal liability under state and/or federal law, while carefully crafted job descriptions and applications can assist an employer both in finding and hiring valuable employees and for evidentiary purposes in lawsuits and administrative charges.

Job descriptions

After a Pennsylvania employer decides to fill a new position or a current position, the first step it should take is to create or revise the applicable job description.  The job description should be a thorough listing of the duties, skills, education, training, experience, and physical and mental attributes required in the job.

Well-developed job descriptions can provide at least three benefits to an employer:

• an employer will have a better idea about the type of skill-sets and personality traits of a person who would perform well in the job. 
• an employer can use the job description to prepare and ask useful interviewquestions. 
• a job description, especially one listing the “essential functions of the job,” can help insulate the employer from claims of disability discriminationby a job applicant who is not hired or by an employee who is terminated.  This is particularly important for employers covered by the Americans with Disabilities Act (ADA), Title VII, Affirmative Action Plan/Program (AAP) mandates, and Pennsylvania Human Relations Act (PHRA).

There are certain statements that it may be advisable for a job description to contain, including the following:

• a statement as to the employment-at-willrelationship – as discussed in Chapter 1, Introduction, it is important to make sure that the job applicant really understands this relationship
• a statement that the employer reserves the right to modify, interpret, or apply the job description in any way the company desires and that the job description is not a contractfor employment
• if the employer is covered by the ADA, Title VII, AAP mandates, or PHRA, a statement that the job description does not necessarily include every duty, or every “essential duty,” of the position – language such as this helps protect an employer from discriminationclaims under the ADA or PHRA.

Two sample job description formats have been provided below. They are not intended to cover every job and should be tailored, with the advice of an employment attorney, for the various jobs within the organization.

Job descriptions, presented to an applicant may also screen out applicants who dislike or misunderstood the nature of the position.

Job description

FORM 1

ABC Company

JOB DESCRIPTION

 

JOB TITLE:              [Self explanatory]

 

JOB IDENTIFICATION

 

Department:                                        [Self explanatory]

Job Code:                                            [Self explanatory]

Location:                                             [Self explanatory]

Reports to:                                          [Self explanatory]

Employees Supervised/Directed:        [Self explanatory]

Pay Grade:                                          [Self explanatory]

FLSA Code:                                        [Self explanatory]

 

JOB PURPOSE AND SUMMARY

[Provide a general one or two sentence statement of the main purpose of the job.]

DUTIES AND RESPONSIBILITIES

Essential Functions Of The Job

[List essential functions of the job in order of importance with “1” being the most important function.  The essential functions include the duties that are (a) the reason the position was created, (b) regularly performed by the person who holds the position, and/or (c) a significant percentage of all the duties performed an employee in the position.  Reasons why a function may be considered essential include the following (1) the position exists to perform the function, (2) there are a limited number of other employees available to perform the function or among whom the function can be distributed, (3) the function is highly specialized and the person in the position is hired for special expertise or ability to perform it.]

Important But Non-Essential Functions Of The Job

[List non-essential job functions.  Non-essential functions are tasks an employee must be able to perform occasionally or on an intermittent, non-regular basis.  This may include the requirement that an employee must “perform any other duties and/or tasks that may be assigned to him/her on an as needed basis.”  Note that just because a function is performed infrequently, does not mean that the function is non-essential.  Consider placing safety-related and other critical duties under the list of essential functions.]

Qualifications:

Educational Requirements

[List the essential education requirements.  If only a high school education is required make sure to note that a high school diploma is not the only evidence of that education.  A General Educational Development certificate (GED) is permissible under Pennsylvania law.]

Minimum Experience, Abilities Required and Special Requirements

[List here the number of years of experience required and the knowledge and information generally required to perform the job.  Any specialized skills should be included in this section.]

Physical Requirements of the Job

[The physical functions required to complete the job should be listed in detail.  For example, these physical functions may include: sitting, walking, lifting, eye-hand coordination among others.  In describing the physical requirements, it is important to focus on the goal of the job not on how the job is completed.]

Mental Requirements of the Job

[Describe the mental functions necessary for the completion of the job.  These would include, for example, reading, simple math calculations, multitasking, withstanding moderate amounts of stress, the need to concentrate for extended periods of time, the ability to balance numerous tasks at one time.]

Work Environment

[List the adverse environmental conditions to which the employee may be exposed such as outside weather conditions, noisy environment, etc.]

Reasonable Accommodation for Disability

Any employee, who believes that a reasonable accommodation is required for purposes of federal or state disability law is required to contact Human Resources to begin the interactive exchange process.

Mandatory Overtime

Mandatory overtime should be expected.

Disclaimer

The Employee is an “AT- WILL” Employee subject to termination with or without cause or resignation at any time.

The information provided in this description has been designed to indicate the general nature and level of work performed by incumbents within this job.  It is not designed to be interpreted as a comprehensive inventory of all duties, responsibilities, qualifications and working conditions required of employees, assigned to this job.  Management has sole discretion to add or modify duties of the job and to designate other functions as essential at any time.  This job description is not an employment agreement or contract.

FORM 2

 

Job Title:_____________________________________________________________________________________

Date of this Description:_________________________________________________________________________

Job Summary:_________________________________________________________________________________

 

ESSENTIAL FUNCTIONSof the Job (listed in order of importance):

1.

2.

3.

4.

5.

 

MARGINAL JOB FUNCTIONS:

1.

2.

 

Skills OR SKILL SETS Required to Perform the Duties of the Job:

1.        

2.                    

 

Educational Requirements Needed to Perform the Duties of the Job:

1.        

2.        

 

Weight Lifting (or other physical) Requirements to Perform the Duties of the Job:

1.        

2.        

 

Licensing or Other Special Certifications Required:

1.        

2.        

 

 

Job Description Approved by:_____________________________________________________________________

                                                                                   

Signature/Title:_____________________________________             Date:_______________________________

 

***THIS COMPANY RESERVES THE RIGHT TO MODIFY, INTERPRET, OR APPLY THIS JOB DESCRIPTION IN ANY WAY THE COMPANY DESIRES. THIS JOB DESCRIPTION IN NO WAY IMPLIES THAT THESE ARE THE ONLY DUTIES, INCLUDING ESSENTIAL DUTIES, TO BE PERFORMED BY THE EMPLOYEE OCCUPYING THIS POSITION. THIS JOB DESCRIPTION IS NOT AN EMPLOYMENT CONTRACT, IMPLIED OR OTHERWISE. THE COMPANY REMAINS AN “AT-WILL” EMPLOYER.  QUALIFIED EMPLOYEES WHO REQUIRE REASONABLE ACCOMMODATIONS TO PERFORM THE ESSENTIAL FUNCTIONS OF THE POSITION SHOULD NOTIFY THE HUMAN RESOURCES DIRECTOR.***

 

Job applications

Once a job description has been prepared, an employer can begin the process of screeningfor qualified applicants.  The first step in the applicant screening process is obtaining a completed employment application.  A Pennsylvania employer should only request information in an application or an interviewthat is based on business need.  Soliciting other information can subject an employer to legal liability under civil rights laws such as:

• the Americans with Disabilities Act(ADA)
• the Age Discriminationin Employment Act (ADEA)
• Title VIIof the Civil Rights Actof 1964 (Title VII)
• the Pennsylvania Human Relations Act (PHRA)
• the Federal Fair Credit Reporting Act (FCRA) 

Before providing an application to job applicants, an employer should consult with its employment attorneyto determine whether every inquiry on the application form is proper.

A Pennsylvania employer should not request information in the application process about the following, unless the inquiry is based on a business need.  Inquiries to avoid include the following:

• race
• color
• religion/creed
• sex
• disability
• national origin, ancestry, birthplace, or native language
• genetic information
• age (40 or over)
• medical conditions
• economic status (including previous bankruptcy or disclosure of one wage garnishment)
• marital status, children or child-rearing plans
• pregnancy or plans to become pregnant
• name or address of relatives
• former workers’ compensation claims
• weight and height
• militaryservice
• veteran’s status (unless for Civil Service purposes)
• previous wage garnishments
• arrests (unless accompanied by a statement that an arrest or conviction will not necessarily preclude employment)
• labor union activity
• sexual orientation/sexual preference.

As with the job description, there are certain statements that may be advisable to include.  These statements include the following:

• An Equal Opportunitystatement, such as the following:
  • “We consider applicants for all positions without regard to race, color, creed, religion, national origin or ancestry, sex, age (40 or over), disability, genetic information, veteran status, or any other legally protected status under local, state, or federal law.”
• A statement such as this shows that the employer takes seriously its commitment not to discriminate in its hiring practices against legally protected classes of people, and it also helps remind management, as they are reviewing applications, not to discriminate.
• A statement as to the employment-at-willrelationship, such as the following:
• “We are an “at-will,” equal opportunity employer.”
• As discussed above, it is important to make sure that the job applicant understands this relationship. 
• If the employer wants to condition any offer upon the results of a medicalexamination, it should include a statement to that effect, such as the following:
  • “If a job offer is made, employment may be contingent upon the successful completion and passage of a medical examination, which may include providing body substance (blood, urine and/or hair) samples.”

Pennsylvania employers should remember that it is illegal to conduct a medicalexamination, or to request medical information, prior to extending a conditional bona fide job offer.  Also, although a job offer can be conditioned upon a satisfactory passage of a medical examination, an employer covered by the ADA/PHRA has a duty to provide “reasonable accommodations“ to an applicant or employee.   

• A statement as to the length of time an application remains active, such as the following:
• “This application for employment shall be considered active for a period of time not to exceed  ____ months.  If you wish to be considered for employment beyond this time period, you should inquire as to whether or not applications are being accepted at that time.  At that time, you should also submit another application.”
• A statement such as this limits the duration of an employer’s legal obligations and a job applicant’s rights that may be created by an employer accepting an application. One Hundred Eighty days is used in the sample forms.  That number may be changed based on the employer’s desire.  Note that special provisions apply to Internet applications for employers covered by AAP mandates, which are not discussed in this section.
• OR…
• ·      A statement that applications will not remain active after the current job search is completed.  If an employer has no intention of re-reviewing applications, inform the applicant of that up front.
• ·    A signed statement from the job applicant as to the truth of the information, such as the following:
• “The information provided on the application is true and complete, and I understand that incomplete or false statements may be grounds for refusal to hire or for discipline, up to and including termination, at the time the discrepancy is discovered.”
• A statement, signed by the job applicant, acknowledging that he/she understands the employment-at-willrelationship, such as the following:
• “I understand that employment with the company is “at-will,” which means that employment can be terminated by the company or employee at any time, with or without reason, and with or without notice.  Conversely, I may cease my employment at any time.”
• A statement signed by the job applicant, granting permission to the employer to investigate the information contained in the job application.  A statement such as this helps shield the employer, as well as third parties whom the employer might contact, from claims by the job applicant, including those for invasion of privacy.

We recommend you request references only if you expect to contact those individuals.  If you do not, references may contain or give hints about unnecessary and legally problematic protected class information. 

Four sample employment applications have been provided on pages 17, 20, 26 and 30.  Before using any of these forms or inserting any additional information into any of these forms, employers are strongly encouraged to consult an employment attorney.

We have also added a sample Federal Fair Credit Reporting Act (FCRA) notification and authorization sheet.  That should not be combined with any other forms, but should remain as a free-standing authorization form.

“At-will" employment application 

FORM 1

                                                                       (PLEASE PRINT ALL INFORMATION EXCEPT SIGNATURE)

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACTbut merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of race, color, religion, national origin or ancestry, sex, age (40 or over), disability, veteran status, genetic information, or any other legally protected status under local, state, or federal law.  It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful passage of a medical examination, which may include providing body substance samples.  This application will remain active for 180 days.

                                                  PERSONAL INFORMATION

Name      Last                                   First                       Middle	Social Security #
Home Phone	Work Phone
Please list below your current address and your two (2) other most recent addresses: Current    Street                                             City                                                State                                              Zip                  Since (Mo/Yr)
Street                                           City                                                State                                              Zip                  Since (Mo/Yr)
Street                                           City                                                State                                              Zip                  Since (Mo/Yr)

                                                                     

                                                            EDUCATION

High School Attended	City, County and State			Did you earn a Diploma?
Undergraduate College Attended	City, State	Areas of Study	Degree/Certificate/Diploma
Graduate School Attended	City, State	Areas of Study	Degree/Certificate/Diploma
Trade, Business or Other School	City, State	Areas of Study	Degree/Certificate/Diploma
Military Training	City, State	Areas of Study	Degree/Certificate/Diploma

EMPLOYMENT INFORMATION

Position Applied For:	Date You Can Start Work:	Desired Salary:  $
Do You Prefer:   oFull-Time               oPart-Time	Can You Work:   oWeekends     oEvenings
	oDays             oNights
Please answer all of the following questions. When necessary, note question number and use an extra paper to provide explanations:
1) Are you at least 18 years of age and legally eligible for work in the United States?   oYES      oNO
2) Will you work overtime when necessary?               oYES      oNO
3) Have you received a description of the job or been made aware of the essential functions of the job you are applying for :   oYES     oNO
4) Do you understand the job requirements?                                   oYES     oNO  (If no, please explain)
5) Are you on layoff and subject to recall?                                    oYES      oNO
6) Are you currently bound by a noncompetition or trade secret agreement? (If yes, please explain)      oYES        oNO
7) Have you ever been discharged, asked to resign, or given the option to resign from a job? (If yes, please explain)                          oYES      oNO
8) Have you ever been convicted of, pled guilty or no contest to any crime? (If yes, please explain)    oYES        oNO     (A “yes” answer will not necessarily disqualify you from employment.)

EMPLOYMENT HISTORY

MAY WE CONTACT YOUR PRESENT EMPLOYER?                         oYES    oNO
Please list below your last three (3) employers beginning with the most recent:
Most Recent Employer	City		State	Zip Code		Phone
Position Held                                                                            Dates From/To		Pay Rate Upon Leaving $			Supervisor
Duties                                                                                   Reason for Leaving

 

Next Most Recent Employer	City		State	Zip Code		Phone
Position Held                                                                            Dates From/To		Pay Rate Upon Leaving $			Supervisor
Duties                                                                                   Reason for Leaving
Next Most Recent Employer	City		State	Zip Code		Phone
Position Held                                                                            Dates From/To		Pay Rate Upon Leaving $			Supervisor
Duties                                                                                   Reason for Leaving
Next Most Recent Employer	City		State	Zip Code		Phone
Position Held                                                                            Dates From/To		Pay Rate Upon Leaving $			Supervisor
Duties                                                                                   Reason for Leaving

                                                   JOB-RELATED SKILLS

Please answer the following questions if the position you are applying for requires driving a motor vehicle:

1.      Do you have a valid driver’s license?           oYES      oNO

         (If YES:  Driver’s License Number)_________________________________________

Date of Issue:___________________________

 

2.      Do you have a valid Commercial Driver’s License (“CDL”)?       oYES      oNO

         (If YES:  Driver’s License Number)_________________________________________

Date of Issue:___________________________

 

3.      Have you been convicted of, pled guilty or no contest to any traffic-related offense within the past five (5) years?            oYES      oNO

         (A “yes” answer will not necessarily disqualify you from employment.)

 

4.      Have you had your driver’s license suspended or revoked or had your driving privileges modified by a court of law?   oYES    oNO

         (Suspension or revocation will not necessarily disqualify you from employment.)

 

5.      Please list all states from which you hold or have held a driver’s license:

 

Please use this space to list any special skills you may have that relate to the position applied for:

Please list any professional licenses, designations, certifications, etc. that may relate to the position applied for. Include date granted, name of organization and any other relevant information. 1.   2.   3.

PRESENT EMPLOYER

1.      May we contact your present employer?      oYES      oNO

 

2.      Provide name and number of immediate supervisor:___________________________

 

APPLICANT’S CERTIFICATION AGREEMENT

1.        I authorize the investigation of all statements contained in this application and release from all liability any persons or employers supplying such information, and I also release the company from all liability that might result from making the investigation. 2.        I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or on any required documents) will be cause for denial of employment or immediate discipline, up to and including termination of employment, regardless of when or how discovered. 3.        I agree, if I am offered and accept a position, to conform to all existing and future Company rules and regulations and I understand that the Company reserves the right to change policies, title, job description, wages, hours and working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE “AT-WILL,” MEANING THAT EITHER PARTY CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON, AND THAT ONLY A WRITTEN AGREEMENT BETWEEN THE PRESIDENT OF THE COMPANY AND ME, SIGNED BY BOTH OF US,  CAN ALTER THE “AT-WILL” EMPLOYMENT RELATIONSHIP.  CONVERSELY, I MAY RESIGN AT ANY TIME. 4.        I agree, if given a conditional job offer, to submit to a pre-employment medical examination and/or drug testing, and understand that I must meet the qualifications (physical and mental) for the position, with or without reasonable accommodation in order to begin employment.  5.        I understand that any employment offer is contingent upon my providing, within three (3) working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986. 6.        I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.                                                                                                                                                                                                           Signature                                                                                       Date

FORM 2

Support/Clerical Position

(Please Print)

Position Applied for:	Date of Application:
How Did You Learn About Us? □  Advertisement           □  Friend        □  Walk-In       □  Internet □  Employment Agency             □  Relative     □  Other______________________________

 

Last Name                                                                                          First Name                                                                        Middle Name
Address                                                                                                                 City                                                State                            Zip Code
Telephone Number(s)	Social Security Number

 

If you are under 18 years of age, can you provide required proof of your eligibility to work?

oYes    oNo        

     

Have you ever filed an application with us before?            oYes    oNo                                        If Yes, give date           

Have you ever been employed with us before?       oYes   oNo             If Yes, give date             

Are you currently employed?         oYes  oNo

May we contact your present employer?   oYes   oNo

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?      

Proof of citizenship or immigration status will be required upon employment.    oYes    oNo

On what date would you be available to work?                                            

Are you available to work:             o  Full Time   o  Part Time    o  Shift Work     o  Temporary

Are you currently on “layoff” status and subject to recall?                           oYes    oNo

Can you travel if a job requires it?  oYes  oNo

Have you been convicted of, pled guilty or no contest to a crime within the last seven (7) years?

      oYes    oNo

         A “yes” answer will not necessarily disqualify an applicant from employment.

If Yes, please explain                                                                                                                    

This application will remain active for one hundred eighty (180) days.

 

EDUCATION

	Name and Address of School		Course of Study		Years Completed		Diploma Degree
Elementary School
High School
Undergraduate College
Graduate Professional
Military Training
Other (Specify)
Indicate any foreign languages you speak, read, and/or write
		Fluent		Well		Fair
Speak
Read
Write
Describe any specialized training, apprenticeship, skills and extra-curricular activities.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

(cont’d)

EMPLOYMENT EXPERIENCE

Start with your present or last job. Include volunteer activities.  Summer positions or position unrelated to the position for which you are applying need not be included.  You may exclude organizations that indicate race, color, religion, national origin or ancestry, sex, age (40 or over), disability, genetic information, veterans’ status, or any other legally protected status under local, state, or federal law.

 

1.	Employer		Dates Employed   From             To		Work Performed
	Address
	Job Title		Hourly Rate/Salary Starting         Final
	Telephone Number(s)
	Reason for Leaving
1.	Employer		Dates Employed   From             To		Work Performed
	Address
	Job Title		Hourly Rate/Salary Starting         Final
	Telephone Number(s)
	Reason for Leaving
1.	Employer		Dates Employed   From             To		Work Performed
	Address
	Job Title		Hourly Rate/Salary Starting         Final
	Telephone Number(s)
	Reason for Leaving

                                       

If you need additional space, please continue on a separate sheet of paper.

 

ADDITIONAL INFORMATION

List professional, trade, business, or civic activities and offices held. You may exclude memberships that would reveal race, color, creed, religion, national origin or ancestry, sex, age (40 or over), disability, genetic information, veteran status, or any other legally protected status under local, state, or federal law: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Other qualifications Summarize special job-related skills and qualifications acquired from employment or other experience. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

State any additional information you feel may be helpful to us in considering your application.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

(cont’d)

References

1.       2.         3.		_________________________________________(         )________________ Name                                                                                                                                          Phone # ________________________________________________________________________________________ Address _________________________________________(         )________________ Name                                                                                                                                          Phone # ________________________________________________________________________________________ Address ________________________________________________________________________________________ _________________________________________(         )________________ Name                                                                                                                                          Phone # ________________________________________________________________________________________ Address ________________________________________________________________________________________
	*WE ARE AN “AT-WILL,” EQUAL OPPORTUNITY EMPLOYER*

 

FOR PERSONNEL DEPARTMENT USE ONLY

Position(s) Applied For Is Open:             oYes     oNo   Position(s) Considered For:                                                                               Date                             NOTES:

 

Applicant’s Statement

I certify that answers given herein are true and complete to the best of my knowledge.    I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.    I understand that this application for employment shall be considered active for a period of time not to exceed one hundred eighty (180) days and that if I wish to be considered for employment beyond this time period, I should inquire as to whether or not applications are being accepted at that time.   I hereby understand and acknowledgethat, if hired, my employment relationship withthis organization would be of an “AT-WILL” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time and for any or no reason. It is further understood that this “AT-WILL” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in WRITING BY an authorized executive of this organization.   In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge or a refusal to hire.  I understand, also, that I am required to abide by all rules and regulations of the employer.   I agree, if given a conditional job offer, to submit to a pre-employment medical examination and/or drug testing, and understand that I must meet the qualifications (physical and mental) for the position, with or without reasonable accommodation in order to begin employment.     ____________________________________                _________________________   Signature of Applicant                                         Date

*WE ARE AN “AT-WILL,” EQUAL OPPORTUNITY EMPLOYER*

 

FOR HUMAN RESOURCES  DEPARTMENT USE ONLY

Arrange Interview        oYes     oNo ____________________________ INTERVIEWER                                                                     DATE Employed     oYes   oNo                         Date of Employment______________________   Hourly Rate/Job Title                                           Salary___________ Department__________________________            By                                                                                                                                NAME AND TITLE                                                                                  DATE

 

FORM 3

FOR OFFICE USE ONLY
Work Location _______ Position _______	Rate _______ Date _______

 

 

We consider applicants for all positions without regard torace, color, creed, religion, national origin or ancestry, sex, age (40 or over), disability, genetic information, veteran status, or any other legally protected status under local, state, or federal law.    We will give this application every consideration. However, in accepting it, the Company makes no commitment of employment to the applicant.  This application will remain active for one hundred eighty (180) days.   WE ARE AN “AT-WILL” EMPLOYER, MEANING THAT EITHER THE EMPLOYER OR THE EMPLOYEE MAY END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.

                                       BASIC INFORMATION: Please print in ink

Position Applied For:	Date of Application:
How Did You Learn About Us? o  Advertisement                   o  Friend         o  Walk-In o  Employment Agency         o  Relative      o  Other______________________

 

Last Name                               First Name                                                      Middle Name
Address                                                                      City                                 State            Zip Code
Telephone Number(s)	Social Security Number

 

Compensation requirements:                                                     Date Available:                               

Have you been convicted of, pled guilty or no contest to a crime within the last seven (7) years?            oYes   o No

(Conviction will not necessarily preclude employment.)

If yes, please explain:                                                                                                                                                                                                                                                                                                                                                                                                                        

Are you a United States Citizen?       o Yes     o No

            If no, are you lawfully authorized to work in the United States?        o Yes    o No

 

*WE ARE AN “AT-WILL,” EQUAL OPPORTUNITY EMPLOYER*

 

EMPLOYMENT HISTORY:  Start with your present or most recent job. Include self-employment, summer and part-time jobs.

 

1	Company	Address	Telephone
Dates             From                To   Employed		Starting                                Leaving Salary	Supervisor
Your Duties:
Reason for Leaving:
2	Company	Address	Telephone
Dates             From                To   Employed		Starting                                Leaving Salary	Supervisor
Your Duties:
Reason for Leaving:
3	Company	Address	Telephone
Dates             From                To   Employed		Starting                                 Leaving Salary	Supervisor
Your Duties:
Reason for Leaving:
4	Company	Address	Telephone
Date               From                To   Employed		Starting               Leaving Salary	Supervisor
Your Duties:
Reason for Leaving:

 

If presently employed, why do you desire to change your position?_______________________

______________________________________________________________________________

 

If you are now employed, may we contact your present employer?     oYes    o No

 

*WE ARE AN “AT-WILL,” EQUAL OPPORTUNITY EMPLOYER*

 

 

REFERENCES:(not former employers or relatives)

Name	Address	Phone Number

 

EDUCATION:

School	Name and                Address               of School	Course of            Study	Circle Last       Year Completed	Did You Graduate?	List Diploma or Degree
High			1  2  3  4	oYes o No
College			1  2  3  4	oYes o No
Military Training			1  2  3  4	oYes o No
Other   (Specify)			1  2  3  4	o Yes o No

 

If you did not graduate, why did you leave school or college?_____________________________

______________________________________________________________________________

 

Are you planning to pursue further studies?    oYes    oNo                      

                                                                        If yes, oDay OR oNight School

If so, when, where, and what courses?_______________________________________________

______________________________________________________________________________

______________________________________________________________________________

 

INTERESTS:Use this space below to describe interest in the                                industry and skills and aptitudes that you feel qualify you for a position with our Company. (You may wish to include civic and community activities, professional societies in which you participate, hobbies, sports, special training or skills such as typing, accounting, and the like.)  If you need more space, please continue on a separate sheet.

______________________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

 

 

*WE ARE AN “AT-WILL,” EQUAL OPPORTUNITY EMPLOYER*

 

ACKNOWLEDGMENT

Please Read Before Signing:

The facts set forth in my application for employment are true and complete.  I understand that if employed, false or misleading statements on this application shall be considered immediate cause for dismissal.

 

I understand that, if the Company employs me, EITHER THE Company or I can terminate my employment with or without cause at any time and for any or no reason.  This is commonly referred to as “at-will” employment.  I also understand that no official of the Company other than the [Chief Executive Officer] has any authority to enter into an agreement for employment for any specific period of time or to make any agreement contrary to the foregoing.

 

 

 

                                                                                                                                               

Signature of Applicant                                                                         Date

           

 

 

 

 

 

                     *WE ARE AN “AT-WILL,” EQUAL OPPORTUNITY EMPLOYER*

FORM 4

 

The Company is an equal opportunity employer and will not discriminate against any applicant on the basis of any characteristic that is protected by local ordinance, state, federal law.

 

THE COMPANY IS AN “AT-WILL” EMPLOYER, MEANING THAT EITHER THE EMPLOYER OR EMPLOYEE CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.

 

Position Applied For:_______________________________ Date of Application:____________

 

Date You Can Start:_______________________________            Please note that this application, if unsolicited,  will only remain active for six (6) months, after that which the applicant will need to reapply.

 

Name:__________________________________________       Social Security #:_____________

            Last                             First                            Middle

 

Present Address:________________________________________________________________

                                    Street                                                   City                 State              Zip

 

Permanent Address:_____________________________________________________________

                                    Street                                                   City                 State             Zip

 

Telephone #: Home (_____)___________________    Work  (_____)______________________

 

Are you 18 years or older?     oYes    oNo

 

Are there any hours or days of the week you cannot work?     oYes    oNo

              If so, when?_____________________________________________________________

 

Compensation Desired____________________ 

 

Type of Employment:      oFull-time    oPart-time

 

Are your employed now?      oYes    oNo 

            May we contact your present employer?    oYes    oNo

 

Did you ever apply to this Company before?     oYes    oNo    Where?___________________

 

            Under what name? _____________________________  When?_____________________

 

EDUCATION:

	NAME AND ADDRESS OF SCHOOL	NO. OF YEARS ATTENDED	DID YOU   GRADUATE?	SUBJECT/ MAJOR
Elementary School
High School
College
Military Training
Specialized Training

 

Are you lawfully entitled to be employed in the United States?      oYes    oNo

Have you ever been convicted of, pled guilty or no contest to a crime except a minor traffic violation?      oYes    oNo

      

      (A “yes” answer will not necessarily rule out your employment.)

If so, please state citation, date and place where offense occurred:_________________________

______________________________________________________________________________

______________________________________________________________________________

Please provide any additional information such as special skills, training, management experience, equipment operation, or qualifications you feel will be helpful to us in considering your application:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

 

REFERENCES:  list three (3) individuals not related to you, whom you have known for at least one (1) year.

 

NAME	ADDRESS & TELEPHONE	RELATIONSHIP	YEARS ACQUAINTED

 

Emergency Contact______________________________________________________________

                                    Name/Street/City/State/Telephone

 

CURRENT AND FORMER EMPLOYERS:(most recent one first)

 

DATE MONTH/ YEAR	NAME, ADDRESS & TELEPHONE NO. OF EMPLOYER	SALARY: STARTING/ENDING	LAST POSITION HELD/ RESPONSIBILITIES	REASON FOR LEAVING
From:       To:
From:       To:
From:       To:
From:       To:
From:       To:

 

 

 

*  *  *

Please read the following statement carefully before signing to indicate your understanding:

 

I understand that if I receive a conditional job offer, and prior to beginning employment, I may be requested to undergo a pre-employment medicalexamination and/or drugtesting. In the event that I have a disability that will affect my ability to take the test, I will so inform the Company prior to the administration of the test so that a reasonable accommodationcan be made. The Company reserves the right to require medicaldocumentation regarding the need for accommodation.

 

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application may result in a refusal to hire or, if I am hired, discipline up to and including termination.

 

I understand and agree that, if hired, my employment is “AT-WILL.”  THIS MEANS THAT, IF I AM HIRED, EITHER THE COMPANY OR I CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME, WITH OR WITHOUT NOTICE, AND FOR ANY OR NO REASON.

 

I authorize investigation of all statements contained in this application for any employment-related purpose. I release the listed references and all employers to provide you with any and all applicable information they may have. I hereby release these references and former employers from all liability for any information they may give to you, including but not limited to any defamation claims I may now have or will have against them.

 

 

 

________________    ______________________________________________________

Date                            Signature

 

 

 

 

*THE COMPANY IS AN “AT-WILL,” EQUAL OPPORTUNITY EMPLOYER*

 

 

 

 

 

 

Interviewed By:________________________ Date:_________________ Hired:     oYes    oNo

 

Starting Date:____________________ Position:_______________ Wage:______________

 

 

 

FORM 1

 

Disclosure and Authorization

Federal Fair Credit Reporting Act

 

The position for which I have applied at COMPANY (“COMPANY”) requires the direct handling of cash transactions, cash deposits, personal and confidential credit information as well as other private, confidential business information requiring a successful candidate to demonstrate a history of trustworthiness.

 

To proceed with consideration for this position, I understand that I must provide consent for COMPANY to review my credit history and other background information through a credit reporting agency.  That information is considered a “consumer report” under the Federal Fair Credit Reporting Act (“FCRA”).  COMPANY has provided me with a summary of my rights under the FCRA, including my right to receive a review and if necessary, correct such reports.

 

I hereby give my consent for COMPANY or its agents to obtain any information considered a “consumer reports” under that law.  I understand this includes but not limited to work experience, general reputation, criminal history, credit worthiness and verification of licenses.  If I am hired, I also authorize full release of such information throughout the duration of my employment at COMPANY. 

 

I also certify that the information provided below is correct.  Incorrect information will be considered cause for my termination at any time. 

 

Signature:                                                        Date:                                      

 

 

Printed Full Name:                                                                                         

 

Other Names Used (Maiden or Other):                                                         

 

Social Security No.:                                       

 

Date of Birth:                                                 

 

Current Address:                                                                                           

 

 

 

 

 

 

Enclosure: Summary of Rights Under the FCRA