Job descriptions and applications

 

Before beginning the employment application and hiring process an employer should prepare a comprehensive job description for the position to be filled.  This will allow the employer to identify the exact qualifications required for the position and to evaluate each candidate consistently according to those criteria.

Job descriptions

Once a job description has been prepared, an employer can begin the process of advertising the available position and screening qualified applicants.  The first step in the candidate screening process (see Chapter 3, Candidate screening) is the employment application.  It is important that the application request only information pertinent to the job in question.  Employers should not request any information that would indicate the applicant’s age, such as the applicant’s birth date or graduation dates or specific years of attendance for any education institutions the applicant may have attended – requesting or obtaining such information creates the potential for claims of age discrimination by an unsuccessful applicant.  Likewise, employers should not request any information that might reveal a physical or mental impairment that could be considered a disability.  In that regard, employers are limited to asking whether the applicant is capable of performing the essential functions of the job.

Four sample employment applications have been provided in this manual.  All are limited to legally permissible inquiries.  Employers are strongly encouraged to consult with legal counsel before revising any of these forms to request additional information.

 

Job description

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 Required to Perform the Duties of the Job:

1.        

2.                    


Educational Requirements Needed to Perform the Duties of the Job:

1.        

2.        


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:_________________________


***THE 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 EMPLOYMENT RELATIONSHIP REMAINS “AT-WILL.”  QUALIFIED EMPLOYEES WHO, BECAUSE OF A PHYSICAL OR MENTAL IMPAIRMENT THAT SIGNIFICANTLY LIMITS A MAJOR LIFE ACTIVITY,  REQUIRE A REASONABLE ACCOMMODATION TO PERFORM THE ESSENTIAL FUNCTIONS OF THIS POSITION SHOULD NOTIFY THEIR MANAGER OR HUMAN RESOURCES.***

 

 

 

Sample 1:  Application for at-will employment


(PLEASE PRINT ALL INFORMATION EXCEPT SIGNATURE)

 

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACTbut merely is intended to provide information necessary 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 sex, race, color, religion, age, marital status, national origin, citizenship, genetic information, disability, veteran status, or any other status protected 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 completion of a medical examination, which may include a drug test or other physical evaluations.  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 other most recent previous 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 & 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

 


                                                 
EMPLOYMENT INFORMATION
Position Applied For:

 

Date You Can
Start Work:

 

Desired Salary:  $
Do You Prefer:   oFull-Time               oPart-Time

 

Can You Work:   oWeekends     oEvenings

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 or asked to resign from a job? (If yes, please explain)                                oYES      oNO
8) Have you ever been convicted of or pled guilty to any felony or misdemeanor other than minor traffic violations?  (If yes, please explain)    oYES       oNO 

 

(This question does not pertain to convictions that have been sealed or classified as youthful offender adjudications.   An affirmative response will not automatically disqualify you from being considered as a candidate for employment.)
EMPLOYMENT HISTORY

 

MAY WE CONTACT YOUR PRESENT EMPLOYER?                         oYES    oNO
Please list below your last three 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

 

If the position you are applying for requires driving a motor vehicle, Please answer the following questions:
1.               Do you have a valid driver’s license?           oYES      oNO

 

                  (If YES:  Driver’s License Number)_________________________________________ 
Date of Issue:___________________________

2.               Have you been convicted of or pled guilty to any traffic-related offense within the past five years?                  oYES      oNO

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

 

4.               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.
APPLICANT’S CERTIFICATION AGREEMENT

 

1.        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 termination of employment, regardless of when or how discovered.
2.        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.

 

3.        If I am offered and accept a position, I agree to conform to all existing and future Company rules and regulations and I understand that the Company reserves the right to change 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.
4.        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.

 

5.        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

 


Sample 2:  Application for at-will employment

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, marital or veteran status, genetic information, disability, or any other legally protected status.
(Please Print)

 

Position Applied for:
Date of Application:

 

How Did You Learn About Us?
□  Advertisement            □  Friend       □  Walk-In

 

□  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?
□  Yes               □  No

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 a crime within the last 7 years?     oYes   oNo
This question does not pertain to convictions that have been sealed or classified as youthful offender adjudications as provided under New York law.  Conviction will not necessarily disqualify an applicant from employment.

If Yes, please explain                                                                                                                        
                                                                                                                                                         

 

                                                                                                                                                         
This application will remain active for 45 days.

Education

 

Name and Address of School
Course of Study
Number of Years
Completed
Diploma
Degree

 

Elementary School

High School

Undergraduate College

Graduate Professional

 



Other (Specify)

Indicate any foreign languages you speak, read, and/or write

 

          
            FLUENT      GOOD        FAIR      

SPEAK





READ

 


WRITE

 



Describe any specialized training, apprenticeship, skills and extra-curricular activities.

 

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 


Describe any job-related training received in the United States military.

 

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



Employment Experience
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations that indicate race, color, religion, gender, national origin, disabilities, or other protected status.

 

1.

 

Employer

Dates Employed
Work Performed

 


From
To

 


Address



Telephone Number(s)

Hourly Rate/Salary


Starting

 

Final

Job Title

 



Reason for Leaving

 



2.
Employer

 

Dates Employed

 

Work Performed

From

 

To

Address

 



Telephone Number(s)

 

Hourly Rate/Salary

 



Starting
Final

 


Job Title



Reason for Leaving


3.

 

Employer

Dates Employed
Work Performed

 


From
To

 


Address



Telephone Number(s)

Hourly Rate/Salary


Starting

 

Final

Job Title

 



Reason for Leaving

 



4.
Employer

 

Dates Employed

 

Work Performed

From

 

To

Address

 



Telephone Number(s)

 

Hourly Rate/Salary

 



Starting
Final

 


Job Title



Reason for Leaving


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

 


List professional, trade, business, or civic activities and offices held.

You may exclude memberships that would reveal gender, race, religion, national origin, age, ancestry, genetic information, disability, or other protected status:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Additional Information

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

 

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Specialized Skills:    Check Skills/Equipment Operated
Production/Mobile

 

oCRT                        oFax                                      Machinery (list):            Other (list):
oPC                          oLotus 1-2-3                                                              ___________

 

oCalculator               oPBX System         PPP        _____________            ___________
oTypewriter              oWord Processing         PPP             _____________          ___________

 

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

 


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.

 

This application for employment shall be considered active for a period of time not to exceed 45 days.

 

Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

 

I 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. I understand, also, that I am required to abide by all rules and regulations of the employer.

 




____________________________________                Signature of Applicant         Date

 




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

 

FOR PERSONNEL 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

 



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

 

 

Sample 3:  application for at-will employment

 

FOR OFFICE USE ONLY
Work

 

Location _______
Position _______

 


Rate _______

 

Date _______

(An Equal Opportunity Employer)
We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status,  disability, genetic information, or any other legally protected status.  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 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

 




Salary requirements:                                                     Date Available:                                

 


Have you been convicted of a crime within the last 7 years?   oYes    o No

 

This question does not pertain to convictions that have been sealed or classified as youthful offender adjudications under New York law.  An affirmative response will not automatically disqualify you from being considered as a candidate for 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 any job-related military service assignments, self-employment, summer and part-time jobs.

1
Company

 

Address
Telephone

 




Dates Employed             
From                To

 

Starting                                Leaving
Salary

 

Supervisor
Your Duties:

 

Reason for Leaving:

 


2

 

Company
Address

 

Telephone


Dates Employed             
From                To

 

 
Starting                                Leaving

 

Salary
Supervisor

 

Your Duties:

Reason for Leaving:

3
Company

 

Address
Telephone

 


Dates Employed            
From                To

 

Starting                                 Leaving
Salary

 

Supervisor
Your Duties:

 


Reason for Leaving:

 


4

 

Company
Address

 

Telephone


Date  Employed              
From                To

 

 
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

 


    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 cause for immediate dismissal.  In making this application for employment I authorize you to make and/or investigate a report whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted.  This inquiry, if made, may include information as to my character, general reputation, personal characteristics, and mode of living.  This inquiry, if made, also may include information concerning any and all employment discrimination claims and/or accusations brought against me, including, but not limited to, charges and/or accusations brought against me that relate to harassment and/or discrimination involving race, sex, age, religion, disability, and/or national origin.

I understand that I have the right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of any such investigation or report that is made.

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.  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*

 


Sample 4:  Application for at-will employment

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, state or 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 will only
                                                                                                                                                                remain active for six months, after 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?____________________________________________________________

Salary 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


Specialized Training

 




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

Have you ever been convicted of a crime, other than minor traffic violations?     oYes   oNo
{ This question does not pertain to convictions that have been sealed or classified as youthful offender adjudications under New York law.   An affirmative response will not automatically disqualify you from being considered as a candidate for 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:  Three Individuals Not Related To You, Whom You Have Known For At Least One 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 medical examination. If I have an impairment 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 accommodation may be arranged. The Company reserves the right to require medical documentation 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 termination.

            I understand and agree that, if hired, my employment is AT-WILL. THIS MEANS THAT, IF HIRED, EITHER THE COMPANY OR I CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME 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*



For Employer Use Only

Interviewed By:________________________ Date:_________________ Hired:   oYes   oNo

Starting Date:____________________Position:_______________ Wage:______________

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