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Employment Application

PLEASE READ CAREFULLY
Note: Fields marked with a * require an answer. Please use "N/A" for "not applicable" if necessary. Applicants may be required to complete and sign a paper application for employment upon interview.
Attach Resume:
*Email:

Applicant Information

*First Name: *Last Name:
MI:
*Address: Apartment/Unit #
*City *State
*Zip
*Phone: Referred By:
Date Available:

Salary Expected:
I can work:  Weekends    Evening    Night
U.S. Citizen:    Yes    No If not, are you authorized to work in the U.S.?:  Yes     No
Languages Spoken:
*Have you ever worked for this company?:  Yes     No
If yes, when?: ------ To ------
*Have you ever been convicted of a felony?
(By company policy some misdemeanors may bar employment):
 Yes     No
If yes, explain briefly:

Education

High School:   Address:
Graduate:    Yes     No   Degree:
College:   Address:
Graduate:    Yes     No   Degree:
Other:   Address:
Graduate:    Yes     No   Degree:

References

Please list three references not related to you, whom you have known at least one year.
Name: Occupation:
Company: Day Phone Numbers:
Address:
Name: Occupation:
Company: Day Phone Numbers:
Address:
Name: Occupation:
Company: Day Phone Numbers:
Address:

Employment History

Company Name: Complete Address
(w/ City, State, Zip):
Phone: Supervisor:
Job Title: Responsibilities:
Starting Salary: Ending Salary:
Start Date:
(mm/dd/yyyy)
  End Date:
(mm/dd/yyyy)
 
Reason for Leaving: May we contact your previous employer for a reference?  Yes    No


Military Service

Start Date:
(mm/dd/yyyy)
End Date:
(mm/dd/yyyy)
Branch: Rank at Discharge:
Type of Discharge: If other than honorable, explain:

Applicant's Statement

Notification and Agreement

I hereby affirm that all information in this application is true and accurate to the best of my knowledge. I understand that the college can obtain criminal history record information on applicants for employment. Pursuant to the requirements of the Fair Credit Reporting Act, notice is given that a consumer report+ may be made in connection with your application for employment. I understand that any misrepresentation or falsification of this record or failure to disclose conviction for a felony or for any offense involving moral turpitude will be considered cause for dismissal.

If you are denied employment, either wholly or partly, because of information contained in a consumer report, a disclosure will be made to you of the name and address of the consumer-reporting agency making such report.

Signature below verifies you have read the above notice and understand what it means.



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