Employment Application Please enable JavaScript in your browser to complete this form.GeneralName *FirstMiddleLastDate of Birth *SSN *Day Phone No. *Night Phone No. *Email *Present Address *Years at Present Address *Previous Address *Years at Previous Address *Mailing Address *Are you 18 years or older? *YesNoThe age Discrimination in Employment Act of 1987 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.If hired, can you provide proof of citizenship or legal right to work in the United States? *YesNoHave you ever plead guilty (including Deferred Adjudication) or been convicted of any criminal offense, other than minor traffic citations? If yes, please explain in the message box below. *YesNoExplain (if you answered yes to the question above): PositionPosition Applied For *Source of ReferralDate *Position Desired *Full-TimePart-TimeSalary Expected *Mon. (availability) *If you are available to work all day and all night shifts just put "all" within the time slots.Tues. (availability) *If you are available to work all day and all night shifts just put "all" within the time slots.Wed. (availability) *If you are available to work all day and all night shifts just put "all" within the time slots.Thurs. (availability) *If you are available to work all day and all night shifts just put "all" within the time slots.Fri. (availability) *If you are available to work all day and all night shifts just put "all" within the time slots.Sat. (availability) *If you are available to work all day and all night shifts just put "all" within the time slots.Sun. (availability) *If you are available to work all day and all night shifts just put "all" within the time slots. Employment HistoryMost Recent EmployerEmployer's AddressPhone NumberSupervisor's NameStart DateEnd DatePosition TitleFinal SalaryReason For Leaving Previous EmployerEmployer's AddressPhone NumberSupervisor's NameStart DateEnd DatePosition TitleFinal SalaryReason For Leaving Previous EmployerEmployer's AddressPhone NumberSupervisor's NameStart DateEnd DatePosition TitleFinal SalaryReason For Leaving Please list below any other work experience relevant to this position and explain any gaps in employment history: Education and TrainingGraduated High School *YesNoType of Degree or CertificateSchool Name and AddressGraduated University or Technical School? *YesNoType of Degree or CertificateSchool Name and AddressDo you have a valid Driver's License? *YesNo Language AbilityAre you bilingual? *YesNoPlease list a language that you can use at work: *Speak *YesNoRead *YesNoWrite *YesNoPlease list a language that you can use at work:SpeakYesNoReadYesNoWriteYesNo SkillsComputer Software SkillsOffice Machinery SkillsMonths of Cash HandlingOther ReferencesName/TitleReference 1Mailing AddressPhoneName/TitleReference 2Mailing AddressPhoneName/TitleReference 3Mailing AddressPhone AuthorizationDigital Signature *I HEREBY AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU. 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 SHALL BE GROUNDS FOR TERMINATION. I UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINED TIME PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT ANY PRIOR NOTICE.Date *NO PERSON SHALL BE DENIED EMPLOYMENT ON THE BASIS OF RACE, COLOR, ETHNICITY, NATIONAL ORIGIN, SEX/GENDER, SEXUAL ORIENTATION, RELIGION, CREED OR DISABILITY EMPLOYMENT IS CONTINGENT UPON FURNISHING EVIDENCE OF IDENTITY AND EMPLOYMENT ELIGIBILITYSubmit