Application for Employment

Name *

First

Middle

Last

Address

Street Address

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Transportation to work *

If hired, do you have a reliable means of transportation to get to work? Please Describe

Are you at least 18 years old? *

Yes
No

If the job you are applying for requires driving: Driver’s License No.

State of Drivers License

Expiration Date of Drivers License

Are you legally eligible for employment in the U.S.? *

(Proof of U.S. citizenship or immigration status is required if hired.)

Yes
No

Have you been convicted of a crime?

(Massachusetts applicants should not include misdemeanor convictions; California applicants should not include marijuana-related convictions that occurred more than 2 years prior to the application date.)

Yes
No

If yes, please describe below

If yes, state the nature of the offense and disposition of the case. Include dates and places. (NOTE: The existence of a criminal record does not constitute an automatic bar to employment.)

Are you a veteran?

Yes
No

If yes, give dates of service: Start date of service

List any special skills or training:

Are you seeking full time, part time or temporary employment? *

Full Time
Part Time
Temporary Employment

What hours and shift(s) would you prefer to work? *

List times you are not available to work? *

Are you willing to work overtime?

Yes
No

Are you willing to work holidays?

Yes
No

Are you willing to work weekends?

Yes
No

Are you currently employed?

Yes
No

If hired when would you be able to start?

Have you ever been discharged or asked to resign from any position?

If yes, please describe:

Accommodation

Please describe which tasks, if any, you will need an accommodation to perform, and explain what type of accommodation you will need:

Elementary Education

please select highest level achieved

Secondary Education

please select highest level achieved

Name of High School:

College Education

please select highest level achieved

Location of College:

If in high school, are you enrolled in a recognized co-op program?

Yes
No

If yes, identify program and school:

Describe your work history in as much detail as possible.

Include employer location, contact info, dates of employment, duties, etc.

May we contact the employers listed above?

If not, list the employers you do not wish us to contact and why:

Authorizations & At-Will Employment Agreement

(Please read carefully, then check the I agree box and date below)
I certify that I have personally completed this application. I declare that the information provided in this employment application is true and complete and I understand that any false information or significant omissions may disqualify me from further consideration for employment and may be justification form my dismissal from employment if discovered at a later date. I agree to immediately notify this company if I should be convicted of a crime while my job application is pending or during my employment, if hired.
I authorize this company to make an investigation of all information contained in this employment application and I release from liability all companies and corporations supplying such information. I understand any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge.
I specifically authorize and direct my current and former employers to supply employment-related information to this company and do hereby release my current and former employers from liability for providing information to this company.
Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer.
I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and any other investigative report deemed necessary through various third party sources. As required by law, upon request within a reasonable period of time, I will be notified as to the nature and scope of such investigations.
I hereby agree to submit to any drug test required of me, whether prior to my employment or if employed by this company at any time thereafter. If requested, I will take a post-job offer physical examination and my employment, in the event I receive medical treatment for any condition, including a physical, psychological, emotional, or psychiatric condition that is job-related, I hereby authorize the limited release and exchange of such medical information relating to my condition between the treatment provider and a company-designated physician.
AT-WILL EMPLOYMENT AGREEMENT
I understand and agree that nothing contained in this application, or conveyed during any interview is intended to create an employment contract between the company and me. In addition, I understand and agree that if you employ me, in consideration of my employment, my employment and compensation will be at-will, for no definite period of time, and may be terminated at any time, for any reason, or for no reason at all. I understand that only the company’s President is authorized to change the employment-at-will status and such a change can only be done in writing. I have read, understand, and agree to the above.

I Agree

Please enter today's date

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Application for Employment