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Application for Employment

Name Address
City State
Zip Phone
S. S. No. Position Applied for
Email    

Employment History:

Please begin with your current or last job. Include military service assignments. If you include volunteer activities, please exclude
organizations that might indicate race, color, religion, national origin, disability or other protected status.

 
First Employer

Address

Phone No.

Duties/Responsibilities

From

To

Salary/Wage per Hour Week Month Year $ (start), $ (end)

Job Title

Supervisor

Reason for leaving

   
       
Second Employer

Address

Phone No.

Duties/Responsibilities

From

To

Salary/Wage per Hour Week Month Year $ (start), $ (end)

Job Title

Supervisor

Reason for leaving

   
       
Third Employer

Address

Phone No.

Duties/Responsibilities

From

To

Salary/Wage per Hour Week Month Year $ (start), $ (end)

Job Title

Supervisor

Reason for leaving

   

Specialized Training:
Any specialized training, apprenticeship programs, education, or any special job-related skills

Any honors, awards, copyrights, or patents

Personal:
Have you ever been convicted of a felony? Conviction will not automatically disqualify
you from employment.

Yes
 

If yes, please explain

If applying for a position that requires driving, do you have the appropriate license?

Yes

If applying for a position that requires driving, have you been ticketed for a moving
violation in the last 3 years?

Yes
   

If yes, please explain

References other than previous employers and relative:

Name

Address

Phone or Email

Name

Address

Phone or Email

Name

Address

Phone or Email

Name

Address

Phone or Email

 

If applying for Glass Technician position, list at least three Experienced Glass Technicians who can vouch for your expertise:

Name

Address

Phone or Email

Name

Address

Phone or Email

Name

Address

Phone or Email

Name

Address

Phone or Email

 

Applicant’s Acknowledgement

I certify that answers given in this application are true and complete to the best of my knowledge. I authorize investigation into all statements I have made on this application as may be necessary for reaching an employment decision.

In the event I am employed, I understand that any false or misleading information I knowingly provided in my application or interview(s) may result in discharge and/or legal action. I understand also that if employed, I am required to abide by all the rules and regulations of the employer and any special agreements reached by the employer and me.

This application shall be considered active for no more than 45 days.  After that time, applicants will be required to resubmit a completed application.

The applicant understands that neither this document nor any offer of employment from this employer constitutes an employment contract unless a specific document is executed in writing by the employer and employee.

Unless a specific document is executed in writing by the employer and employee, all employment here is At-Will. Just as an employee may resign for any reason, the employer may terminate an employee for any reason.

I agree that I will settle any and all previously unasserted claims, disputes or controversies arising out of or relating to my application for employment and/or cessation of employment exclusively by final and binding arbitration before a neutral Arbitrator.

 

Yes, I AGREE with the terms and conditions from the Applicant’s Acknowledgement.

No, I disagree with the terms and conditions from the Applicant’s Acknowledgement.

 
     
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