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| Position(s) Applied For Date How did you learn about us? Last Name, First Name, Middle Name Address Telephone Number(s) Social Security Number (Needed for Stock Bonus) Best time to contact you at home is: If you are under 18 years of age, can you provide required Proof of your eligibility to work? Do any of your friends or relatives, other than spouse, work here? If yes, state name, relationship and location Are you currently employed? May we contact your present employer? Are you prevented from lawfully becoming employed in this Country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment. Date available for work What is your desired salary range? Are you available for work: Full Time (Please indicate 1 2 3 shift) Part Time (Please indicate Mornings Afternoons Evenings) Temporary (Please indicate dates available) Write-in answer here: Are you currently on “lay-off” status and subject to recall? Can you travel if a job requires it? WE ARE AN EQUAL OPPORTUNITY EMPLOYER EDUCATION School Name and Address of School Course of Study No. of yearsCompleted Diploma/Degree High School UndergraduateCollege Graduate/ Professional Other(Specify) WORK EXPERIENCE Start with your present or last job. Include any job-related military service assignments, internships, and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. Indicate Employer, Dates Employed, Address, Telephone Number(s), Hourly Rate/Salary Starting, Present Job Title, Starting & Final pay, Supervisor, and Reason for Leaving. State any additional information you feel may be helpful to us in considering your application. Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given. 1 PERSONAL/PROFESSIONAL REFERENCE Name Phone Number Best Time to Call Occupation APPLICANT’S STATEMENT I certify that answers given herein are true and complete.I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision, including the pulling of credit report(s).This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.I hereby understand and acknowledge that unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.In the event of employment, I understand that false information or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations, policies and procedures, of the employer. Type in your name for signature Date © 2002 Michael Joseph Francis Enterprises. All Rights Reserved. Made in the USA. |
