APPLICATION FOR EMPLOYMENT
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.
Last Name
First Name
Middle Initial
Street Address
City, State, ZIP Code
Telephone Number(s)
Social Security Number
If you are under 18 years of age, can you provide proof of your eligibility to work?
Yes
No
Have you ever been employed with us before? If yes, give date
Are you currently employed?
May we contact your present or former employers?
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment.)
Have you ever been convicted of a felony within the last 7 years? (Conviction will not necessarily disqualify an applicant from employment.) If yes, please explain:
On what date would you be available for work?
Are you available for work:
Full Time
Part Time
Temporary
Which shift?
Are you currently on "lay-off" status and subject to recall?
Can you travel if a job requires it?
EDUCATION
High School
Undergraduate College
Graduate/ Professional
Other (specify)
Indicate any foreign languages you can speak, read, and/or write.
Speak
Read
Write
Describe any specialized training, apprenticeship, skills and extra-curricular activities.
Describe any job-related training received in the U.S. military.
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.
Employer Address (Street, City, State, Zip) Telephone Number(s) Job Title Supervisor Work Performed Dates Employed From To Hourly Rate/Salary Starting Final Reason for Leaving Employer Address (Street, City, State, Zip) Telephone Number(s) Job Title Supervisor Work Performed Dates Employed From To Hourly Rate/Salary Starting Final Reason for Leaving Employer Address (Street, City, State, Zip) Telephone Number(s) Job Title Supervisor Work Performed Dates Employed From To Hourly Rate/Salary Starting Final Reason for Leaving Employer Address (Street, City, State, Zip) Telephone Number(s) Job Title Supervisor Work Performed Dates Employed From To Hourly Rate/Salary Starting Final Reason for Leaving List professional trade, business, or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status. Summarize special job-related skills and qualifications acquired from employment or other experience. SPECIALIZED SKILLS
Employer
Address (Street, City, State, Zip)
Job Title
Supervisor
Work Performed
Dates Employed
From
To
Hourly Rate/Salary
Starting
Final
Reason for Leaving
List professional trade, business, or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status.
Summarize special job-related skills and qualifications acquired from employment or other experience.
CRT
FAX
Calculator by Touch
List Others:
PC
MicroSoft Office
Word Processing
Calculator
MicroSoft Word
wpm Typing Speed
Typewriter
Windows ’95
Forklift
Voicemail
Excel
Pallet Jack
WORK REFERENCES Other than Supervisors listed above
APPLICANT'S STATEMENT
I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with Conxall Corporation is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understaood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of Conxall Corporation. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Conxall Corporation.
Name of Applicant
Date
