Application For Employment Form
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1
2Application for Employment
We consider applicants for all positions without discrimination on account of race, color, religion, sex, national origin, age,
disability, sexual orientation, veteran status or any other legally protected categories.
Date __________________
Position Applying For _________________________________________
Personal Information
Name ______________________________________________________
Social Security # ______-____-______
Last
First
Middle
Address ___________________________________________________________
Phone (_____) ________________
Street
City
State
Zip
Are you at least 18 years of age? ______
If under 18 years of age, can you obtain a work permit?__________________
Date Available to Start _____________
Do you have the legal right to remain and work in the United States? Yes _____ No_____
After employment, can you submit proof of citizenship or legal entry into this county? Yes _____ No _____
Have you ever been convicted of a crime? Yes _____ No _____
If yes, explain_________________________
________________________________________________________________________________________________
(Answering yes will not necessarily bar you from employment. Applicants are not required to disclose any judicially sealed or expunged conviction re-
cords or the existence of such records. Applicants should exclude marijuana-related convictions that occurred over 2 years prior to the application date.)
How were you referred to this company? Online ________
Relative ________
Friend ________ Other___________
Have you ever applied before? Yes _____ No _____
If yes, when? _____________
Where? _____________
Names of friends and relatives working for this company: ___________________________________________________
Languages spoken:
□ English
□ Spanish
□ Bilingual
□ Other __________________________
Availability
Total Weekly Hours Desired ____________
Wage Expected ____________
How will you get to work? _____________________________________
List hours available for work:
Tue
Wed
Fri
Mon
Thu
Sun
Sat
From
To
Education
Circle last grade completed:
Grade: 5 6 7 8
High School: 9 10 11 12 G.E.D.
College: 1 2 3 4
Name and address of last school attended _______________________________________________________________
Special skills or training that would qualify you for this position _______________________________________________
________________________________________________________________________________________________
Hobbies and interests _______________________________________________________________________________
________________________________________________________________________________________________
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Parent category: Business