Employment Application Page 2
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1
2
3EMPLOYMENT APPLICATION
AN EQUAL OPPORTUNITY EMPLOYER
(PRINT) LAST NAME
FIRST
MIDDLE
SOCIAL SECURITY NUMBER
DATE OF APPLICATION
PRESENT ADDRESS (INCLUDING ZIP CODE)
PHONE NO (INCLUDING AREA CODE)
POSITION DESIRED
CELL PHONE NO. (INCLUDING AREA CODE)
TYPE OF EMPLOYMENT DESIRED (CIRCLE)
SHIFT PREFERENCE (CIRCLE)
E-MAIL ADDRESS
1
2
3
st
nd
rd
FULL TIME
PART TIME
TEMPORARY
SEASONAL
WHO REFERRED YOU TO OUR COMPANY?
SALARY DESIRED
_____Advertisement
_____Employment Agency
_____Friend
_____Walk In
_____ Relative
_____Other
Are you a U.S. citizen or do you have the legal right to work indefinitely in the U.S.? _____Yes
_____No
If applicable, state type of visa: _________________
If you are under 18 years of age, give date of birth ___________
Date Available To Start Work ____________________________
Have you ever applied for work here before? _____Yes, Enter Date ________________
_____ No
Can you work overtime if necessary? ______ Yes
______ No
Do you have relatives or friends now employed at Cornell? _____ Yes
_____ NO
If yes, please list name(s):_______________________________________________________________________________________________________
FROM
TO
MONTH & YEAR
Either a
DEGREE
COURSE OF
NAME OF SCHOOL
LOCATION
OF
Diploma or
(BA, MA,
STUDY
GRADUATION
GED
BS etc)
MO.
YR.
MO
YR.
Yes
No
High
School
Technical
Vocational
School
College
Other
Please list any special qualifications or skills
BRANCH OF ARMED
ACTIVE DUTY
RANK
MAJOR DUTIES
SERVICE
FROM
TO
ENTRY
RELEASE
MO
YR
MO
YR
RESERVE STATUS
BRANCH
LIST NO ACTIVITY (UNLESS YOU WISH) WHICH REVEALS YOUR RACE, RELIGION, SEX, AGE, NATIONAL ORIGIN OR DISABILITY
SCHOOL, ATHLETIC, CLASS,
COMMUNITY & BUSINESS,
VOLUNTEER ACTIVITIES
SCHOLASTIC, SOCIAL
SOCIAL, PROFESSIONAL
(Unpaid Work Experience)
HAVE YOU EVER BEEN CONVICTED OF A CRIME (EXCLUDING MISDEMEANORS AND TRAFFIC OFFENSES? _____YES
_____ NO
IF YES, LIST CONVICTIONS:
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Parent category: Business