Employment Application

Last Name

First Name

Middle Name

Street

City

State

Telephone Number

Message Number

Are you 18 years or older?

Yes No

Are you legally authorized to work in United States?

Yes No

As required by law, documents that prove identity and elegibility to work must be provided at time to hire.

Position Applied For

Do you want to work

Specify days an hours available, if part-time

Date available to start to work

Salary expectation

Have you applied for employment with this company whitin the last 12 month?

Yes No

Have you ever worked for us before? (Please provide your name of record at that time,job title and dates of employment)

Yes No

Educational Background

High School Technical College College Graduate School

Did you Graduate?

Yes No

Diploma/Degree/Certificate

Please describe any special job-related skills and qualifications acquired from employment, other education or volunteer experiences,etc. Do not include experiences which would indicate race, religion, sex, national origin, genetic information, disability or age or any other status protected by law or regulation.

Has your employment with any employer ever been involuntary terminated?

Yes No

If yes, please identify the employer(s), date of termination(s) and reason(s) for termination:

(Please Start with your present or most recent positon)

Name of Employer

Dates Employed

Name and title of supervisor

Brief description of your work and responsabilities

Name of Employer

Dates Employed

Name and title of supervisor

Brief description of your work and responsabilities

APPLICANT: Please read the following carefully before signing this application.

I understand that the misrepresentation or omission of facts on this application, on my resume or during any stage of the hiring process will eliminate me from further consideration or if discovered after hire may result in the termination of my employment.

I understand that the information contained in this employment application or my being invited to participate in any stage of the hiring process is NOT intended to create an employment contract between this Company and myself. If an employment relationship is established, I understand that I have the right to terminate my employment at any time, for any reason or no reason, with or without notice, and this Company has the right to terminate my employment at any time, for any reason or no reason, with or without notice. This Company's policies and procedures, including employment at-will, cannot be modified in any way without express written intent to do so by the senior business leader of this organization.

I understand that an offer of employment is contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States. Unless otherwise noted above, I authorize this Company and its representatives to contact my prior employers, former supervisors and company personnel, schools and all others for the purpose of verifying the information I have supplied during the selection process and for obtaining job-related information regarding my knowledge, skills, abilities, performance of duties and compliance with policies. I authorize my prior employers to provide this Company any job-related information, personal or otherwise, they may have regarding me and I release this Company and them from any liability resulting from the release of this information. I further authorize all employers, schools and other persons to provide any information or transcripts that may be requested by this Company which will be used to determine if I am qualified to perform the job duties for which I am applying.

I understand that if selected I may have access to or work with sensitive, proprietary, trade secret and confidential information and agree not to disclose it unless there is a legitimate business reason to do so and only to those with a need to know.

I understand that the company may conduct a criminal background investigation of me for the position for which I am applying and that a separate authorization to do so will be required. A conviction is not an automatic bar to consideration and/or employment. The company will consider the nature, date and circumstances of the offense, amount of time that has elapsed since the conviction and/or completion of the sentence, any evidence of rehabilitation efforts, as well as the relationship and/or relevance between the offense and the duties of the position sought.

I certify the information given by me is true in all respects.