Authored by: David L. Barron

Job descriptions and applications

 

The first step an employer should take before beginning the employment application and hiring process is writing a comprehensive job description for the position needing to be filled.  This will allow the employer to specify the exact qualifications required for the position and will assist greatly in the hiring process.  Do not include functions or require credentials that are not related to that particular job.  False requirements frequently prove troublesome in any related employment disputes. 

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 information pertinent to the job at hand.  Employers are advised not to request any information that would provide the employer with the age of the applicant, such as the applicant’s birth date or graduation dates pertaining to any education institutions the applicant may have attended.  If such information is provided, it could lead to allegations of age discrimination by the applicant if he or she was not chosen for the position.

Four employment applications have been provided in this manual.  All are acceptable in the questions they ask the applicant.  Before inserting any additional information into any of these forms, employers are strongly encouraged to obtain legal counsel. 

Important:  The authorization for an investigation of the information provided only applies to inquiries made by employees of the employer itself.  If the employer uses an outside service or a third party to gather information as part of its background check on applicants, then a separate authorization form is mandatory in order to comply with the Fair Credit Reporting Act. 

 

Job description

 

Job Title:______________________________________________________________________

Date of this Description:__________________________________________________________

Job Summary:__________________________________________________________________

 

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

1.

2.

3.

4.

5.

 

OTHER 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.        

 

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:_________________________

 

***THE COMPANY RESERVES THE RIGHT TO MODIFY, INTERPRET, OR APPLY THIS JOB DESCRIPTION.  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.” ***


Job description

 

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

[The essential functions of the job should be listed 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

[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, as a GED is permissible.]

 

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

[This section should describe the mental functions necessary for the completion of the job.  These would include, for example, reading, simple math calculations, 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.

 

Employment application

 

                                                                       (PLEASE PRINT ALL INFORMATION EXCEPT SIGNATURE)

THIS APPLICATION IS NOT AN OFFER OR CONTRACT OF EMPLOYMENT.  It is usedto 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, national origin, citizenship, genetic information, disability, veteran status, or any other status protected under 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 background check, drug screen and/or medical examination.  This application will remain active for 30 days.

                                                    PERSONAL INFORMATION

Name:     Last                                   First                       Middle

 

Social Security #

Home Phone / Cell Phone

 

Work Phone

Please list below your current address and your two 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 & State

Did you earn a Diploma/GED?

Undergraduate College Attended

 

City, State

Areas of Study

Degree/Certificate/Credit Hours

Graduate School Attended

 

City, State

Areas of Study

Degree/Certificate/Credit Hours

Trade, Business or Other School

 

City, State

Areas of Study

Certificate/Diploma/Credit Hours

         

                                                                             

EMPLOYMENT INFORMATION

Position Applied For:

Date You Can

Start Work:

Desired Compensation: 

$

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 extra paper to provide explanations:

1) Are you at least 18 years of age and legally eligible to work in the United States?  oYES    oNO

2) Will you work overtime upon request?   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 / nonsolicitation / nondisclosure agreement? oYES        oNO  (If yes, please explain)


7) Have you ever been discharged or asked to resign from a job?                 oYES      oNO  (If yes, please explain)

8) Have you ever been convicted of, pled guilty or no contest to, or had deferred adjudication for a felony or other non-traffic crime? (Conviction will not necessarily disqualify an applicant from employment.)        oYESoNO  (If yes, please explain)

oYES       oNO

 

EMPLOYMENT HISTORY

MAY WE CONTACT YOUR PRESENT EMPLOYER?                         oYES    oNO

 

 

 

Please list below, ALL of your prior employers (regardless of how brief) beginning with the most recent.  Use extra paper if needed.

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

 

               

Continue on extra paper if more than 4 prior employers.  Below explain any periods of unemployment.

 

 

 

 

                                                                             

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:  State & Driver’s License Number)__________________________________ Date of Issue:___________________________

 

2.  Have you been convicted of ,  obtained deferred adjunction for,  or pled guilty to any traffic-related offense within the past five years?

        oYES                oNO  (If yes, please explain)

______________________________________________________________________________________________________________________

3.  Have you had your driver’s license suspended or revoked or had your driving privileges modified by a court of law?    oYES      oNO  (If yes, please explain)__________________________________________________________________________________________________________

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 and AGREEMENT

1.        I authorize the investigation by the company 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 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 wages, hours and working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE AT-WILL, MEANING THAT EITHER THE COMPANY OR I CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON, and that my at-will status can only be altered by an express  written agreement signed by myself and the chief executive officer of the company .

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

 

 

Employment application

 

We consider applicants for all positions without regard to race, color, religion, gender, national origin, genetic information, age, veteran status, qualified 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

 

 

 

 

 

Can you provide required proof of your eligibility to work in the United States?     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

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 ever been convicted of, pled no contest, or obtained deferred adjudication for a crime?

oYes   oNo      (Conviction will not necessarily disqualify an applicant from employment.)

 

If Yes, please explain                                                                                                                         

                                                                                                                                                                                                                                                                                                                   

 

This application will remain active for 30 days.

Education

 

 

Name and Address of School

 

Course of Study

Years/Hours

Completed

Diploma/

Degree

 

Elementary

School

 

 

 

 

 

High

School

 

 

 

 

 

Undergraduate

College

 

 

 

 

 

Graduate

Professional

 

 

 

 

 

Other

(Specify)

 

 

 

 

 

 

 

Indicate any foreign languages you speak, read, and/or write that will assist in the position sought

 

           

FLUENT

GOOD

FAIR

 

SPEAK

 

 

 

 

READ

 

 

 

 

WRITE

 

 

 

 

 

Describe any specialized training, apprenticeship, skills and extra-curricular activities that will assist in the position sought.

 

_______________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

                   
 

 


Employment Experience

List ALL prior employers, starting with the most recent. Include any job-related military service assignments.  You may also include volunteer activities if you wish.

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, you must continue on a separate sheet of paper.

Explain any gaps in employment:________________________________________________________________________

 ________________________________________________________________________                      


 

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

______________________________________________________________________________________________________________________________________________

                                                        

Additional Information

 

Specialized Skills:    Check Skills/Equipment Operated

oWord                      oFax                                      Machinery (list):            Other (list):

oPC                          oSpreadsheet                                                              ___________

oCalculator               oScanner                              _____________            ___________

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

______________________________________________________________________________________________________________________________________________________________

 

 

References

 

1.

 

 

 

2.

 

 

 

 

3.

 

_________________________________________(         )________________

Name                                                                                                                                          Phone #

________________________________________________________________________________________

Address                                                                                                       Relationship

_________________________________________(         )________________

Name                                                                                                                                          Phone #

________________________________________________________________________________________

Address                                                                                                        Relationship

________________________________________________________________________________________

_________________________________________(         )________________

Name                                                                                                                                          Phone #

________________________________________________________________________________________

Address                                                                                                          Relationship

________________________________________________________________________________________

 

 

 


Applicant’s Statement

I certify that answers given herein are true and complete to the best of my knowledge. 

 

I authorize investigation by the company 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 30 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 would be of an “AT WILL” nature, which means that EITHER THE EMPLOYER OR I CAN TERMINATe the employment relationship at any time and for any or no reason. I further understand that the “AT WILL” status of the employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by the chief executive oFFICER.

 

In the event of employment, I understand that false, misleading, or omitted information 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

 

 

 


 

FOR HUMAN RESOURCE DEPARTMENT USE ONLY

 

  Position(s) Applied For Is Open:       oYes  o   No

 

Position(s) Considered For:                                                                               Date                           

 

NOTES:_______________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

 

 

                                             

 

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

 

FOR HUMAN RESOURCE DEPARTMENT USE ONLY

 

Arrange Interview        o   Yes                 o   No

 

                                                                              ____________________________

  INTERVIEWER                                                           DATE

 

  Employed     o   Yes     o   No                 Date of Employment  _________________________

 

                                          Hourly Rate/

  Job Title                                           Salary                           Department  __________________________

 

           By                                                                                                                              

                                   NAME AND TITLE                                                                                  DATE

 

 

 

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


Employment application

        FOR OFFICE USE ONLY

Work

Location _______

Position _______

 

Rate _______

Date _______

 

 

(An Equal Opportunity Employer)

We consider applicants without regard to race, color, religion, sex, national origin, age, veteran status, qualified disability, genetic information, or any other legally protected status.  In accepting this application, the Company makes no commitment of employment.

This application will remain active for 30 days.

                                     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

 

 

 

 

 

Hourly rate/salary requirements:                                                     Date Available: _______________

 

Have you been convicted of, pled no contest to, or obtained deferred adjudication for a crime?                oYes    o No    If yes, please explain.  (A conviction will not necessarily result in disqualification):                                                                                                                                                                                                                                                                                                                      

                                                                                                                                                           

Are you eligible to work in the United States?             o Yes     o No

 


EMPLOYMENT HISTORY:  List ALL prior employment, regardless of how brief, starting with the present/most recent. Include any military service, self-employment, summer and part-time jobs. Add extra sheets if necessary.

 

1

 Company

 Address

        Telephone

 

 

 

 

Dates              From                To

Employed:

Starting            Pay                 Leaving

 

        Supervisor

Your Duties:

 

2

 Company

 Address

        Telephone

 

 

 

 

  Dates             From                To

  Employed:

Starting            Pay                Leaving

 

        Supervisor

  Your Duties:

 

  Reason for Leaving:

 

3

 Company

 Address

        Telephone

 

 

 

 

  Dates             From                To

  Employed:

Starting            Pay                Leaving

 

        Supervisor

  Your Duties:

 

  Reason for Leaving:

 

4

 Company

 Address

        Telephone

 

 

 

 

  Date               From                To

  Employed:

Starting Pay                Leaving

 

        Supervisor

  Your Duties:

 

  Reason for Leaving:

 

Continue on extra paper if more than 4 prior employers.

 

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

 

Explain any gaps in employment: _____________________________________________

_________________________________________________________________________

 


REFERENCES:(Not former employers or relatives)

                    Name/Relation

 

                         Address

Phone Number

 

 

 

 

 

 

 

 

 

 

EDUCATION:

   School

             Name and

               Address

              of School

        Course of

           Study

Circle Last

      Year

Completed

  Did You

Graduate?

Diploma Degree

Hours

     High

                     

               

 1  2  3  4         

oYes

oNo

 

   College

 

 

 

 1  2  3  4         

oYes

oNo

 

    Other

  (Specify)

 

 

 1  2  3  4         

oYes

oNo

 

 

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

______________________________________________________________________________

 

Are you planning to pursue further studies?    oYes     o  No          

 

If yes,  o  Day    o  Night School

 

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

______________________________________________________________________________

______________________________________________________________________________

 

INTERESTS:Use this space below to describe interest in this 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.)  If you need more space, please continue on a separate sheet.

______________________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

 


ACKNOWLEDGMENT

Please Read Before Signing:

The facts set forth in my application for employment are true and complete.  I understand that if employed, false, misleading, or omitted information 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.  I also understand that only 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

           


 

 

Employment application

 

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

 

Position Applied For:_______________________________ Date of Application:____________

Date You Can Start:_______________________________

                                                                                                          

Please note that this application will only  remain active for 30 days, 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 or Cell(_____)____________________

 

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?_____________________

 

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

 

Have you ever been convicted of, pled no contest, or had deferred adjudication for a crime except a minor traffic violation?    oYes     oNo

       {This question pertains only to convictions that have not been sealed or expunged}.

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

______________________________________________________________________________

______________________________________________________________________________

 


EDUCATION:

 

 

 

NAME AND ADDRESS OF SCHOOL

NO. OF

YEARS

ATTENDED

 

DID YOU

  GRADUATE?

 

SUBJECT/

MAJOR

Elementary

School

 

 

 

 

High School

 

 

 

 

 

College

 

 

 

 

Specialized

Training

 

 

 

 

 

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:  3 Individuals Unrelated To You, Whom You Have Known For At Least 1 Year.

 

 

NAME

 

ADDRESS & TELEPHONE

 

RELATIONSHIP

YEARS

ACQUAINTED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


CURRENT AND ALL FORMER EMPLOYERS:(Most Recent One First)

DATE

MONTH/

YEAR

NAME, ADDRESS & TELEPHONE NO. OF EMPLOYER

PAY RATE:

STARTING/ENDING

LAST POSITION HELD/

RESPONSIBILITIES

REASON FOR LEAVING

From:

 

 

 

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Continue on separate paper if more than 5.  Include all prior employment regardless of how brief.

Explain any gaps in the above listed employment:______________________________________

______________________________________________________________________________

 

*  *  *


Read the following statement carefully before signing to indicate your understanding:

 

I understand that if I receive a conditional job offer, my employment may be conditioned upon successful completion of a background check, drug screen, and or medical examination.

 

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, false, misleading or omitted information 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 and that any exception must be in an express written agreement signed by myself and the Chief Executive Officer of the Company.  

 

I authorize investigation by the Company 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 the Company, 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:______________