EMPLOYMENT - empirenortheast.com

Standard Application for Employment

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications.

Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application. You may attach a resume, but all questions must be answered.

Employer

Position applying for

First Name

Middle Name

Last Name

Address

Address Line 1

City

State

Zip Code

Home Phone

Business Phone

Cell Phone

Date you can start work

Salary Desired

Do you have a High School Diploma or GED?

Yes

Position Information
Check all that you are willing to work

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

Yes

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

Yes

If yes, explain:

Have you been told the essential functions of the job or have you been viewed a copy of the job desciption listing the essential functions of the job?

Yes

Can you perform these essential functions of the job with or without reasonable accommodation?

Yes

Qualifications
Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training.

School

School Name

Degree

Address

Address Line 1

City

State

School

School Name

Degree

Address

Address Line 1

City

State

Other

Address

Address Line 1

City

State

Special Skills
List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.)

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.

First Name

Last Name

Address

Address Line 1

City

State

Phone

Relationship

First Name

Last Name

Address

Address Line 1

City

State

Phone

Relationship

First Name

Last Name

Address

Address Line 1

City

State

Phone

Relationship

Work History
Start with your present or most recent employment and work back. Use separate sheet if necessary. (INCLUDE PAID AND UNPAID POSITIONS).

Job Title #1

Company Name

Starte Date

Supervisor's Name

End Date

Phone

Address

Address Line 1

City

State

Zip Code

Reason for leaving

Duties

Starting Salary

Ending Salary

May we contact your present employer?

Yes

N/A

Job Title #2

Company Name

Start Date

Supervisor's Name

End Date

Phone

Address

Address Line 1

City

State

Zip Code

Reason for leaving

Duties

Starting Salary

Ending Salary

Job Title #3

Company Name

Starte Date

Supervisor's Name

End Date

Phone

Address

Address Line 1

City

State

Zip Code

Reason for leaving

Duties

Starting Salary

Ending Salary

Job Title #4

Company Name

Starte Date

Supervisor's Name

End Date

Phone

Address

Address Line 1

City

State

Zip Code

Reason for leaving

Duties

Starting Salary

Ending Salary

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.

Applicant Signature

Date