Employment Application

Available Start Date *

Position Applying For *

Are you legally eligible to work in the U.S.? *

YES NO

Have you ever been convicted of a felony? *

YES NO

Work Availability (Please let us know when you are available to work, ie. Monday-Thursday 9-5 & Saturday morning). *

Education

Employment History

Company Name (2) *

Contact Name *

Contact Phone Number *

May we contact this person? *

YES NO

Date of Employment *

Job Title *

Responsibilities (Job Description) *

Reason for Leaving *

By checking this box, I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me, or for discharge should I be hired. I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment. I also authorize you to request and receive such information. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added or interpreted at any time, at the company’s sole option and without prior notice to me. I also acknowledge that my employment may be terminated, or any offer or acceptance of employment withdrawn, at any time, with or without cause, and with or without prior notice at the option of the company or myself.