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Application For Employment
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*Your Name
First and last, please
 
*Contact Phone
numbers only, include area code, please
 
*Zipcode
please tell us your zipcode so we know how to route your request
 
*E-mail
*Social Security Number: 
xxx-yy-zzzz
11/24/2008
* Have you ever been
employed here before? 
Yes No
If yes, please give dates and positions:
 
Current Employer:
Current Employer Phone:
area code, too, please
Current Montly Salary: /month
just numbers, please
Reason for Leaving:
 
* Do you have a
high school diploma? 
Yes No
* Do you have a
college degree? 
Yes No
 
Applicant Statement
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 (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational 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 this application remains current for only 30 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.

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 I may be required to fill out additional paperwork prior to my employment.

DO NOT SUBMIT UNTIL YOU HAVE
READ THE ABOVE APPLICANT STATEMENT
By submitting this application, I certify that I have read, fully
understand and accept all terms of the foregoing Applicant Statement.
   

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