Fillable Application For Employment Form (Page 3 of 3) in pdf

Educational Background

A. List last three (3) schools attended, starting with most recent. B. List number of years completed. C. Indicate

degree or diploma earned, if any. D. Grade Point Average or Class Rank. E. Major field of study.

A. School

B. # of

C. Degree/Diploma

D. GPA/

E. Major

Yrs. Completed

Class Rank

_________________________________________________________________________________________

College

_________________________________________________________________________________________

College

__________________________________________________________________________________

High School/GED

References

List name and telephone number of three business/work references who are not related to you and are not previous

supervisors. If not applicable, list three school or personal references who are not related to you.

NUMBER OF

NAME

PHONE

YEARS KNOWN

______________________________________________________________________________________________

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient

cause to cancel further consideration of this application, or immediately discharge me from the employer’s service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all

references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify

the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I

may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the

employment process and all other persons, corporations or organizations for furnishing such information about me.

BACKGROUND CHECKS MAY INCLUDE PUBLICLY ACCESSED SOCIAL NETWORKING SITES.

I understand that this application remains current for 12 months. At the conclusion of that time, if I have not heard from the employer and

still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that just as I am free to resign at any time, my employer reserves the same right to end our employment

relationship at any time, with or without notice and with or without cause, for any reason not prohibited by law. This application does not

constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or

representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to

the foregoing express language are valid unless they are in writing and signed by the employer’s Chief Executive Officer.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that

federal immigration laws require me to complete an I-9 Form in this regard.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT

I certify that I have read, fully understand, and accept all terms of the above Applicant Statement.

Signature of Applicant ___________________________________________ Date ________________________

Application For Employment Form Page 3

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