Employment Application Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Position Applied for: * Are you a citizen of the United States? * Yes No If no, are you authorized to work in the U.S.? Yes No Do you consent to a background check? * Yes No Availability Date available to begin work: * Full-time or Part-time? * Full time Part Time How many hours can you work weekly? * Can you work nights? * Yes No Days available to work: * Tuesday Wednesday Thursday Friday Saturday Sunday Education High School or Equivalent: Location: Did you graduate? Yes No College: Location: Diploma: References Please list three professional references Reference #1 - Full Name: Company: Location: Relationship: Phone: Reference #2 Reference #2 - Full name: Company: Location: Relationship: Phone: Reference #3 Reference #3 - Full Name: Company: Location: Relationship: Phone: Previous Employment Please list three previous employers. Previous Employment #1 - Company name: Location: Job Title: Supervisor: Phone: From: MM DD YYYY To: MM DD YYYY Reason for Leaving: May we contact your previous supervisor for a reference? Yes No Previous Employment #2 Previous Employment #2 - Company name: Location: Job Title: Supervisor: Phone: From: MM DD YYYY To: MM DD YYYY Reason for Leaving May we contact your previous supervisor for a reference? Yes No Previous Employment #3 Previous Employment #3 - Company name: Location: Job Title: Supervisor: Phone: From: MM DD YYYY To: MM DD YYYY Reason for Leaving: May we contact your previous supervisor for a reference? Yes No Military Service Branch: From: MM DD YYYY To: MM DD YYYY Rank at Discharge: Type of Discharge: If other than honorable, explain: Disclaimer and Consent I certify that my answers are true and complete to the best of my knowledge. If this application leads to my employment, I understand that false or misleading information in my application or interview may result in my release. Full Name: Date MM DD YYYY Thank you!
