Employment Application

First Name

Last Name

Street Address and/or Mailing Address

Telephone Number

Date you can start work

Salary Desired

Do you have a High School Diploma or GED?

Yes No

Are you authorized to work in the U.S. on an unrestricted basis?

Yes No

Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.)

Yes No

If yes, explain:

Special Skills

Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don’t have three professional references, then list personal, unrelated references

Reference

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application. I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.

Check Box to Agree