Employment Application Web Site First Name * Last Name * Last Four Digits of SSN * Present Address * Permanent Address * Are You 18 Years Or Older? * Yes No Date of Birth Contact Number * Alternate Contact Number Email Address Desired Employment Desired Position * Date You Can Start * Salary Desired * Are You Employed Now? Yes No If So, May We Inquire Of Your Present Employer? * Yes No Supervisor Name Supervisor Phone Ever Applied for This Company Before? * Yes No When and Where? Ever Worked For This Company Before? * Yes No When and Where? Reason For Leaving Name Of Last Supervisor At This Company Who Referred You To This Company Employment Agency Newspaper Advertising Friend State Employment Office College Placement Service Walk-In Website Other Education Grammar School Name & Location of School Subject Studied High School Name & Location of School Subjects Studied College Name & Location of School Subjects Studied General Subjects of Special Study or Research Work Special Training Special Skills Former Employers List Below the Last Three Employers, Starting with the Most Recent Name of Present/ Last Employer Address Start Date Leaving Date Job Title Weekly Starting Salary Weekly Final Salary Description of Work May We Contact Your Supervisor Yes No Name of Supervisor Title Phone Reason for Leaving Name of Present/ Last Employer Address Start Date Leaving Date Job Title Weekly Starting Salary Weekly Final Salary Description of Work May We Contact Your Supervisor Yes No Name of Supervisor Title Phone Reason for Leaving Name of Previous Address Start Date Leaving Date Job Title Weekly Starting Salary Weekly Final Salary Description of Work May We Contact Your Supervisor Yes No Name of Supervisor Title Phone Reason for Leaving By submitting and transmitting this application, you are indicating that you have read this statement and agree to its terms. I certify that the information contained in this application is correct to the best of my knowledge and understand that falsification is grounds for immediate for rejection of this application, or, if hired, grounds for termination of employment. I authorize any references that I have listed, or previous employers, to give all information concerning my previous employment and release all parties for any damage which may result from such information. If hired, I understand and agree to conform to the job requirements and rules, in writing and otherwise, and agree that such requirements and rules may change from time to time, be modified or amended. I agree that if hired my employment is for an indefinite period of time and that the company may change my wages, benefits, working conditions or job locations. I accept and understand that, if hired, and as a condition of continued employment, the business needs may require that I work over time, shift work, a rotating schedule, a schedule other than Monday through Friday, and/or travel. I further agree, if hired, and requested by management to submit, at any time, to a search of my person or any desk or other furniture that may be assigned to me, and I herby waive all claims for damages due to this search. I further agree and acknowledge that, if hired, me employment and compensation may be terminated at any time, with or without cause, and with or without notice, or prior warnings, probations or suspensions at the option of either the company or myself without liability for wages or benefits except such as may have been earned at the date of such termination. I understand that no one, other than the President, Vice President or other Executive Board member of this company has any authority to enter into, or make any agreement contrary to the forgoing. I further understand that this is an application for employment and that no offer of employment is being made at this time.