Position Applying For Personal Information Current Address Permanent Address (if different from above) I am an U.S. Citizen or otherwise authorized to work in the United States on an unrestricted basis Yes No If applicable, please list your visa type, visa # and expiration Have you ever been convicted of a felony? Yes No If you answered yes, please explain Employment History Present or Most Recent Employer Duties Reasons for Leaving Prior Employer Duties Reasons for Leaving Education High School Did you graduate? Yes No If you did not graduate, did you receive your GED? Yes No College or University Did you graduate? Yes No Additional Education (ie Graduate School) Did you graduate? Yes No Degree Other References Please list the names of three references, to which you are not related to. Name Address Business Years Known 1. 2. 3. Position Information Position Applying For How did you hear about this job? What hours are you willing to work? Would you be able to work weekends? Yes No When would you would you be able to start? Desired salary
I hereby certify that my answers and assertions set forth in this application are true and complete to the best of my knowledge. If I am employed, I understand that any false statements on this application shall be considered sufficient cause for my dismissal. I hereby authorize this company to investigate any aspect of my prior educational, and employment history.
Furthermore, I understand that if I am hired, employment with this company is "at will," which means that either the company or I can terminate my employment for any reason not prohibited by state or federal law.