Job Application

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Name

First

Last

Phone Number

Street Address

City, State, Zip

as If Name

Date Applicant Can Start Work?

Position Applicant is Applying

Hourly Pay Desired?

Are you authorized to work in the United States on an unrestricted basis?

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

If Yes please explain. A conviction will not disqualify you from all positions.

Do you have a high school diploma or GED?

References

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.

Work History (List the Last 3 Jobs)

Start with your present or most recent employment and work back. (INCLUDE PAID AND UNPAID POSITIONS) Include Company, Position, Address, Phone, and Length of Employment.

Electronic Signature ( Please type Name as Listed on ID)

First

Last

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.

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