Application for Employment PLEASE PRINT

Position(s) Applied For__________________________________________________________________________ Date of Application ______/______/______

Name __________________________________________________________________________________________________________________________
LAST FIRST MIDDLE

Address_________________________________________________________________________________________________________________________
STREET CITY STATE ZIP CODE

Telephone (______)___________---_____________________________ Social Security Number _______________-- _________ -- ________________

AREA CODE

If you are under 18, can you furnish a work permit? …………………………………………………………………………………………………………. YES NO

Have you ever been employed here before? …………………………………………………………………………………………………………………. YES NO

Are you legally eligible for employment in this country? (Proof of U.S. citizenship or immigration status will be required upon employment.)…………………………. YES NO

Date available of work ______/______/______

Type of employment desired…………. Full Time Part-time Temporary Seasonal Educational Co-op

Are you able to meet the attendance requirements of the position? ………………………………………………………………………………………... YES NO

Have you been convicted of a felony in the last seven (7) years? ………………………………………………………………………………………….. YES NO
(Such conviction may be relevant if job related, but does not bar you from employment.)

If yes, please explain: _____________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

Driver’s license number (if required by job) __________________________________________________________________________ State ___________

How did you find out about this job?: __________________________________________________________________________________________________

Employment History
List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience.
From To Employer Telephone (include area code)

Job Title Address

Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities

Reason for leaving Hourly Rate / Salary

Start $ per / Final $ per

From To Employer Telephone (include area code)

Job Title Address

Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities

Reason for leaving Hourly Rate / Salary

Start $ per / Final $ per

From To Employer Telephone (include area code)

Job Title Address

Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities

Reason for leaving Hourly Rate / Salary

Start $ per / Final $ per

From To Employer Telephone (include area code)

Job Title Address

Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities

Reason for leaving Hourly Rate / Salary

Start $ per / Final $ per

MG300 AN EQUAL OPPORTUNITY EMPLOYER

Application for Employment PLEASE PRINT

Skills and Qualifications

Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work with our company.

Educational Background

Name and Location Years Completed Did you Graduate? Course of Study
High School

College Major Degree

Other

References

Name Telephone Years Known

INCLUDE AREA CODE

PLEASE READ……………………………………………………………………………………………………………………………………………………………………………………….
• It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application
and / or separation from the Employer’s service if I have been employed.

• I give the Employer the right to investigate all references and to secure additional information about me, if related. I hereby release from liability the
Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

• The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for
the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state, or federal law.

• This application is current for only 60 days. At the conclusion of this time, if I have not heard from the Employer and still wish to be considered for
employment, it will be necessary to fill out a new application.

• I understand that as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without cause
and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.

Date: / /
Signature of Applicant

MG300 AN EQUAL OPPORTUNITY EMPLOYER