NON-DOT EMPLOYMENT APPLICATION

Date(Required)

MM slash DD slash YYYY

Employee Information

Name(Required)

First Middle Last

Home Phone(Required)

Cell Phone

Position Applied for

Expected Pay Rate

When will you be available to begin work?

Apart from absences for religious observance, are you available for full-time work?

Yes

No

If not what hours are you available to work?

Will you work overtime of asked?

Yes

No

Are you eligible to work in the United States?

Yes

No

Have you ever been convicted of any crimes in the past ten years, excluding misdemeanors and summary offenses, which have not been annulled, expunged or sealed by a court?

Yes

No

If YES Describe In Full: Have you ever been bonded?

Yes

No

If “YES” with what employers?

EDUCATION: Please Provide Name & Location of all that Apply

High School: Did you graduate?

Yes

No

College: Did you graduate?

Yes

No

Course of Study

Military

Did you serve in U.S Armed Forces?

Yes

No

If “YES” what Branch

Describe any training received relevant to the position for which you are applying:

PAST EMPLOYMENT

Address: Company Name

Phone

Position: Supervisor

Dates of Employment- from to

Describe Your Work: Reason for Leaving:

PAST EMPLOYMENT - 2

Reason For Leaving: PAST EMPLOYMENT - 3

Reason For Leaving: PAST EMPLOYMENT - 4

Reason For Leaving: Additional Information

Other Special Training Of Skills (languages, Machine Operation, Etc.) Consent(Required)

I fully understand and accept all terms and conditions in the below statement.

Please read and understand this statement before signing your application:





The information I have provided in this Application for Employment is true, correct and complete. False, incomplete or misrepresented information of any kind, will be sufficient cause for my application to be rejected or, if discovered after

I am employed, cause for immediate termination of my employment.

I authorize the employer to contact and obtain information about me from previous employer to contact and obtain information about me form previous employers, educational institutions and “references” I provided, any other party necessary to verify the accuracy of information I disclosed in this application, a related employment resume of a personal interview. To assist in the processing of my Applications, I waive all rights to claims I may evaluate my employment request and all other persons, corporations or organizations who provide information for this purpose.

This application will expire in 30 days. After that date, unless otherwise notified, I understand that my status as an applicant will end. I may re-apply for employment in the future by completing a current application.

This application is not an employment agreement. If I accept an offer of employment I understand I may resign at any time, and the employer may terminate my employment at any time with or without cause and without prior notice, unless required by law. I understand that no one, other than an executive officer of the employer, has authority to enter into any employment agreement with terms contrary to the foregoing and then only in writing signed by such officer.

Applicant Signature(Required)

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