Joey’s Application for Employment

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation 

to the application and/or interview process should notify a representative of the Human Resources Dept.

 

                 Position applied for_______________________________________________________Date of Application____________

 

                 Name___________________________________________________Social Security Number_______________________

 

                 Address___________________________________________________________________________________________

 

                 Telephone______________________________________________________Email Address________________________

 

                 Are you 18 yrs of age or older_______If no, date of birth__________(if under 18 you must be able to provide work permit)

 

                 Have you been employed here before? If yes give dates and positions__________________________________________

 

                 Are you legally eligible for employment in this country?_______________

 

                 Date available for work?___________________What is you desired salary range?_______________________

 

                 Are you able to meet the attendance requirements of the position?____________________________________

 

                 Have you ever pled guilty or no contest to or been convicted of a crime?_______________________________

 

                If yes, please provide dates and details____________________________________________________

                     ANSWERING YES TO THESE QUESTIONS DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT. FACTORS SUCH AS DATE, SERIOUSNESS 

                     AND NATURE OF THE VIOLATION, REHABILITATION AND POSITION APPLIED FOR WILL BE TAKEN INTO ACCOUNT

EMPLOYMENT HISTORY  Starting with the most recent

                 Employer_________________________________Address____________________________________________________

                 Telephone #_________________Job Title__________________________From__________To_____________________

 

                 Supervisor_______________________Reason for leaving____________________________________________________

 

                 Hourly Rate/Salary Starting________________Ending_____________May we contact them?_________

 

                 Work performed and job responsibilities____________________________________________________________________

 

                 Employer_________________________________Address____________________________________________________

 

                 Telephone #_________________Job Title__________________________From_____________To___________________

 

                 Supervisor_______________________Reason for leaving____________________________________________________

 

                 Hourly Rate/Salary Starting________________Ending_____________May we contact them?_________

 

                 Work performed and job responsibilities___________________________________________________________________

 

                 Employer_________________________________Address___________________________________________________

 

                 Telephone #_________________Job Title__________________________From_____________To___________________

 

                 Supervisor_______________________Reason for leaving____________________________________________________

 

                 Hourly Rate/Salary Starting________________Ending_____________May we contact them?_________

 

                 Work performed and job responsibilities___________________________________________________________________

 

                 Employer_________________________________Address___________________________________________________

 

                 Telephone #_________________Job Title__________________________From__________To______________________

 

                 Supervisor_______________________Reason for leaving_____________________________________________________

 

                 Hourly Rate/Salary Starting________________Ending_____________May we contact them?_________________________

 

                 Work performed and job responsibilities____________________________________________________________________

 

Skills and Qualifications

                 Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related 

                 functions in the position for which you are applying.

Education Background

 

                 High School_________________________________________________Did you Graduate?_________

 

                 College__________________________________Graduate?______Course of Study________________

 

                 Other_______________________________________________________________________________

 

                 References_________________________________________________Telephone_________________

 

                 References_________________________________________________Telephone_________________

 

                 References_________________________________________________Telephone_________________

 

Availability

 

                 Mon from____________to_________________       Tues   from_______________to________________

 

                 Wed from____________to_________________       Thurs from_______________to________________

 

                 Fri    from____________to_________________      Sat      from_______________to________________

                 Sun from____________to__________________     How many hours per week would you like to work?    ____________________

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to 

cancel further consideration of this application or immediately discharge me from the employer’s service, whenever it is discovered.

I Expressly authorize, without reservation the employer,  employees or agents to contact and obtain information from all reverences  

(personal and professional) employers, public agencies, licensing authorities and education institutions and to otherwise verify the accuracy 

of all information provided by me in this application resume or job interview. I hereby waive any and all rights and claims I may have regarding 

the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and

all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose 

of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law.

If I am hired, I understand that that I am free to resign at any time with or without cause and without prior notice, and the employer reserves 

the same right to terminate my employment at any time with or without cause and without prior notice, except as may be required by law. 

This application does not constitute an agreement or contract for  employment for any specified period or definite duration. I understand 

that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written 

agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president/owner.

I also understand that if I am Hired I will be required to provide proof of Identity and legal authority to work in the United States and that federal

immigration laws require me to complete an I-9 Form in this regard.

                   I understand that this application remains current for only 90 days. At the conclusion of that time if I have not heard from the employer

                  and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

 

 

Signature of Applicant___________________________________________Date_________________