Application For Employment Form
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1
2APPLICATION FOR EMPLOYMENT
An Equal Opportunity Employer
We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other
status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity
and that selection decisions be based on job-related factors.
Answer each question fully and accurately. No action can be taken on this application until you have answered all questions.
Use blank paper if you do not have enough room on this application. PLEASE PRINT, except for signature on back of
application. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal
preferences or discrimination based upon non-job-related information.
Job Applied for_____________________________________________________________
Today’s Date _________________________
Are you seeking: Full-time
Part-time
Temporary
employment?
When could you start work? ______________
_____________________________________________________________________________
_______________________
Last Name
First Name
Middle Name
Telephone Number
________________________________________________________________________________________________________
Present Street Address
City
State
Zip Code
Are you 18 years of age or older? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
(If you are hired, you may be required to submit proof of age.)
__________________
Social Security #
If hired, can you furnish proof you are eligible to work in the U.S.? Yes
No
Have you ever applied here before?
Yes
No
If yes, when? __________________________________________
Were you ever employed here?
Yes
No
If yes, when? __________________________________________
Have you ever been convicted of any law violation? Include any
plea of “guilty” or “no contest.” Exclude minor traffic violations.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If yes, give details ___________________________________________________________________________________________
(A conviction will not necessarily disqualify an applicant for employment.)
If employed, do you expect to be engaged in any additional business
or employment outside of our job?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If yes, give details ___________________________________________________________________________________________
For Driving Jobs Only: Do you have a valid driver’s license? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Driver’s License Number _______________________________
Class of License_______
State Licensed In ___________
Have you had your driver’s license suspended or revoked in the last 3 years? . . . . . . . . . . . . . . .
Yes
No
If yes, give details: ____________________________________________________________________________________
List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal
____________________________________
race, color, religion, national origin, sex, age, disability or other protected status.)
_____________________________________________________________________________________________________
Number of
Diploma/
Subjects
LIST NAME AND ADDRESS OF SCHOOLS
Years
Degree/
Studied
Completed
Certificate
High School or GED: _________________________________________________________________________________________________
College or University: ________________________________________________________________________________________________
Vocational or Technical: _____________________________________________________________________________________________
What skills or additional training do you have that relate to the job for which you are applying? ____________________________
____________________________________________________________________________________________________________________
What machines or equipment can you operate that relate to the job for which you are applying?____________________________
____________________________________________________________________________________________________________________
MSEC 1.1a (09/02)
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Parent category: Business