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Application for Employment

Step 1 of 5

LAST OR PRESENT EMPLOYMENT EXPERIENCE
Position Title
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor's Name
First Last
Date Employed From
MM slash DD slash YYYY
Date Employed To
MM slash DD slash YYYY
NEXT TO LAST EMPLOYMENT EXPERIENCE
Position Title
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor's Name
First Last
Date Employed From
MM slash DD slash YYYY
Date Employed To
MM slash DD slash YYYY
NEXT TO LAST EMPLOYMENT EXPERIENCE
Position Title
Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor's Name
First Last
Date Employed From
MM slash DD slash YYYY
Date Employed To
MM slash DD slash YYYY

GENERAL INFORMATION
Special Skills: (i.e. bi-lingual, special skills, training, etc.)
Activities: (list extracurricular activities and/or offices held that might relate to the position for which you’re applying)
Explain how your talents will benefit this Company in the position you are applying for.
In your present or last position, what are your standards of success in your job? What have you done to meet these standards?
In the last year, what do you consider the most important contribution you have made to your department or organization? What was your role?
What are some of the most imaginative or innovative things you have done in your present or last position?
REFERENCES
Give the name, address, and telephone number of two (2) references who are not related to you and are not previous employers.
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone

APPLICANT STATEMENT
I hereby certify that the information that is provided on this application is true and complete to the best of my knowledge. I also agree that any falsified information or significant omissions may disqualify me from further consideration for employment and may result in an immediate discharge if discovered at a later date. I authorize a thorough investigation of my past employment, references and activities and agree to cooperate in such investigation and release from all liability or responsibility all persons and corporations requesting or supplying information. A copy of this application on which my signature appears shall be effective for the release of the information requested herein. I agree not to disclose or permit disclosure of any financial or proprietary information or trade secrets of the Company, that may be learned during the course of my application and/or employment.I understand that if employed, my employment will be “at-will”, and that either the Company or I may terminate my employment at any time for any reason or no reason. I acknowledge that I do not rely and have not relied on any representation or statements made by the Company or any of its agents, representatives, supervisors or managers, whether oral or otherwise, that are inconsistent with or differ in any way from the statements presented in this application. In consideration of my employment, I agree to conform to the rules and policies of the Company and understand that no supervisor or representative of the Company has any authority to enter into any agreement or assurances contrary to the Company’s policies. I also understand that this application is not a contract of employment.I also understand that as a candidate for employment, I have read the Drug-Free Workplace Statement. I understand that my employment is contingent upon a successful completion of a drug-screening test administered as a pre-employment condition. The confirmed presence of a controlled substance without adequate explanation will result in the termination of application for employment.
Signature of Applicant*
Drug-Free Workplace Statement
We are committed to providing its employees with a safe work environment and promoting the highest standards of employee health and productivity. Consistent with these commitments, the Company has established an Alcohol and Drug Policy. Our goal is to establish and maintain a work environment that is free from the effects of alcohol and drug use and abuse