Employment Application: Apply for a Job

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 1 year.

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Title: Apply for a Job

Fields marked with an asterisk (*) must be filled out before submitting.

Personal Information

First Name *
Middle Name *
Last Name *
Home Phone *
Work Phone *
Cell phone *
Email Address *

Addresses

Current Address

Street *
City *
State *
Zip Code *
Since (Mo/Yr) *

Prior Address

Street *
City *
State *
Zip Code *
Since (Mo/Yr) *
to (Mo/Yr) *

Education

High School

School Attended
City
State
Diploma Yes
No

Undergrad School

School Attended
City
State
Degree/Cert.
Diploma Yes
No
Area of Study

Grad School

School Attended
City
State
Diploma Yes
No
Degree/Cert.
Area of Study

Other School

School Attended
City
State
Diploma Yes
No
Degree/Cert.
Area of Study

Employment Information

Position Applied For
Date You Can Start
Desired Salary
Do You Prefer
Can You Work Weekends
Evenings
Available M
Tu
W
Th
F
Sa
Su
Are you available for shift work? Yes
No
Not Available

Please answer all of the following questions.

1. Are you at least 18 years of age and legally eligible to work for our company in the United States? Yes
No
If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes
No
2. Have you worked for this business before? Yes
No
If yes, please provide dates and locations.
3. Are you currently bound by a noncompetition, confidentiality or trade secret agreement? Yes
No
If yes, please explain…
4. Have you ever been discharged or asked to resign from a job? Yes
No
If yes, please explain…
5. Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation? Yes
No
If yes, please explain…
6. Do any of your friends or relatives, other than spouse, work here? Yes
No
If yes, state name and relationship…

Employment History

Are you currently employed? Yes
No
May we contact your present employer? Yes
No

Most Recent Employer

Employer *
City *
State *
Zip Code *
Phone *
Position Held *
From (m/yyyy) *
To (m/yyyy) *
Pay upon leaving *
Supervisor *
Duties *
Reason For Leaving *

Prior Employer

Employer
City
State
Zip Code
Phone
Position Held
From (m/yyyy)
To (m/yyyy)
Pay upon leaving
Supervisor
Duties
Reason For Leaving

Prior Employer

Employer
City
State
Zip Code
Phone
Position Held
From (m/yyyy)
To (m/yyyy)
Pay upon leaving
Supervisor
Duties
Reason For Leaving

Prior Employer

Employer
City
State
Zip Code
Phone
Position Held
From (m/yyyy)
To (m/yyyy)
Pay upon leaving
Supervisor
Duties
Reason For Leaving

Job Related Skills

Please answer the following questions if the position you are applying for requires driving a motor vehicle

1. Do you have a valid drivers license? Yes
No
If yes, Drivers License Number
Date of Issue
2. Have you been convicted of or pled guilty to any traffic-related offense within the past five years? Yes
No
If yes, please explain…
3. Have you had your drivers license suspended or revoked or had your driving privileges modified by a court of law? Yes
No
If yes, please explain…
4. Please list all states from which you hold or held a drivers license
5. Please use this space to list any special skills you may have that relate to the position applied for
6. Please list any professional licenses, designations, certifications, etc. that may relate to the position applied for. Include date granted, name of organization, and any other relevant information.

References

Reference 1

Name
Address
Telephone
Relationship
Years Acquainted

Reference 2

Name
Address
Telephone
Relationship
Years Acquainted

Reference 3

Name
Address
Telephone
Relationship
Years Acquainted

Resume (Text Version)

Copy and Paste a text version of your resume here.

Upload File

Attach a file to your application submission (Permitted File Types: doc,docx,pdf,txt – Max file size: 1045876 bytes)

Applicant Certification Agreement

1. I hereby declare that the information provided by me in this Application for Employment (and in any accompanying resume) is true, correct, and complete to the best of my knowledge. I authorize Expert Human Resources (EHR), and/or its designee, to investigate my past and present employment, education, and activities and verify all data provided to me on this application, on related papers and in interviews. I authorize all individuals, schools, and/or firms named herein to provide any information requested about me. I release from all liability any persons, company, corporations, or educational institutions supplying such information. I release EHR (or its designee) from any and all liability resulting from the verification of such information. I understand that any false statement or material omission on this application, or on any supporting documents, shall be grounds for non-hire or discharge, regardless of when discovered by EHR and/or EHR’s client(s).

2. I understand that my application does not guarantee any type of employment, however, should an employment offer be extended to me and accepted, I will fully adhere to the policies, rules, and regulations of employment of EHR and/or its client(s). I further understand that if I am hired by EHR or EHR’s client(s), my status will be that of an employee-at-will, meaning that I will have no contractual right, express or implied to remain in EHR or EHR’s client(s) employ. I understand that, if I am hired, my employment can be terminated, with or without cause and with or without notice at any time, at the option of EHR or EHR’s client(s) or me. I also understand that no representative of the company has the authority to enter into any oral agreement for employment for a specified period of time or to make an oral agreement contrary to the foregoing.

3. I understand that if I am offered employment at EHR or EHR’s client(s), I will be required to provide evidence of my identity and authorization to work in the United States. I understand that the company may require a physical examination, background check and/or drug and alcohol screening as condition of employment. My signature below constitutes my understanding of the above.

* I have read and understand the Applicant Certification Agreement.
Type Name in Signature Box: *