Application For Employment

California

Equal Employment Opportunity Policy:

We are committed to providing equal employment opportunities to all employees and applicants without regard to race, religion, color, sex, gender identity, sexual orientation, national origin, ancestry, citizenship status, uniform service member status, marital status, pregnancy, age, protected medical condition, genetic information, disability or any other protected status in accordance with all applicable federal, state and local laws.

Position Desired

Part Time Full Time

First Name

Last Name

Present Address

How long have you lived there?

Previous Address

How long did you lived there?

Email

Telephone No

Have you ever worked for this Company before?

Yes No

If yes, please give dates and position:

Are you available to work overtime?

Yes No

Have you ever pled guilty or "no contest" to, or been convicted of, a misdemeanor or felony?

Yes No

If yes, please give the date(s) and details:

Have you been arrested for any matters for which you are currently out on bail or on your own recognizance pending trial?

Yes No

If yes, please give the date(s) and details:

NOTE:

Answering "Yes" to these questions does not constitute an automatic bar to employment. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. (Do not include minor traffic infractions, and convictions for which the record has been sealed or expunged, any conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed, referrals to and participation in any pretrial or post trial diversion programs, and misdemeanor marijuana-related offenses that occurred over two years ago in answering these questions).

RECORD OF PREVIOUS EMPLOYMENT

Please list the names of your present or previous employers in chronological order with present or last employer listed first. Be sure to account for all periods of time including any period of unemployment. If self-employed, give firm name and supply business references. [Add additional page if necessary]

Present or Last Employer Employed Pay Your Title or Position Exact Reason for Leaving
Address From (mo/yr) $ Start Name and Title of Last Supervisor
Telephone To (mo/yr) $ Final
 
Present or Last Employer Employed Pay Your Title or Position Exact Reason for Leaving
Address From (mo/yr) $ Start Name and Title of Last Supervisor
Telephone To (mo/yr) $ Final
 
Present or Last Employer Employed Pay Your Title or Position Exact Reason for Leaving
Address From (mo/yr) $ Start Name and Title of Last Supervisor
Telephone To (mo/yr) $ Final
 
Present or Last Employer Employed Pay Your Title or Position Exact Reason for Leaving
Address From (mo/yr) $ Start Name and Title of Last Supervisor
Telephone To (mo/yr) $ Final

Have you ever been terminated or asked to resign from any job?

Yes No

If yes, please explain circumstances:

Please explain fully any gaps in your employment history:

May we contact your current employer?

Yes No

If No, please explain:

Please indicate any actual experience, special training and qualifications that you have which you feel are relevant to the position for which you are applying.

Have you ever used another name?

Yes No

Is any additional information relative to change of name, use of an assumed name, or nickname necessary to enable a check on your work and educational record? If yes, please explain:

If hired, can you furnish proof that you are over 18 years of age?

Yes No

Do you have adequate transportation to and from work?

Yes No

Education

School Name Years Completed Diploma/Degree Describe Course of Study or Major Describe Specialized Training, Experience, Skills and Extra-Curricular Activities
Elementary: 4 5 6 7 8
High School: 9 10 11 12
College/University: 1 2 3 4
Graduate/Professional: 1 2 3 4
Trade or Correspondence:
Other:

PERSONAL REFERENCES

Please list persons who know you well -- not previous employers or relatives

Name Occupation Address(Street, City and State) Telephone Number Number of Years Known

THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF THIRTY (30) DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY.

I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE AND ACCURATE.

Date

Signature of Applicant


APPLICANT'S STATEMENT & AGREEMENT

  1. In the event of my employment in a position with this Company, I will comply with all rules and regulations of this Company. I understand that the Companymay require me to submit to a test for the presence of drugs in my system prior to employment and at any time during my employment, to the extent permitted by law. I also understand that any offer of employment may be contingent upon the passing of a physical examination. I consent to the disclosure of the results of any physical examination and related tests to the Company. I also understand that I may be required to take other tests such as personality and honesty tests, prior to and during my employment. I understand that should I decline to sign this consent or take any of the above tests, my application for employment may be rejected or my employment may be terminated. I understand that bonding may be a condition of hire. If it is, I will be so advised either before or after hiring and a bond application will have to be completed.
  2. I further understand that the Company may obtain Public Records about me as part of a background investigation.If you wish to receive a copy of any consumer report or investigative consumer report obtained by the Company, please indicate your request by checking this box [ ].
  3. I further understand that the Company may contact my previous employers. I authorize those employers to disclose to the Company all records and information pertinent to my employment with them. In addition to authorizing the release of any information regarding my employment, I hereby waive any rights or claims I have or may have against my former employers, their agents, employees, and representatives, as well as other individuals who release information to the Company, and release them from any and all liability, claims, or damages that may directly or indirectly result from the use, disclosure, or release of any such information by any person or party, whether such information is favorable or unfavorable to me. I authorize the persons named herein as personal references to provide the Company with any pertinent information they may have regarding myself. I also authorize the Company to use social media and other internet resources as part of the pre-employment screening process to the extent permitted by law.
  4. I hereby state that all the information that I have provided on this application or any other documents completed in connection with my employment, and in any interview,is true and accurate. I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand that if I am employed and any information provided to the Company is found to be false or incomplete in any respect, I may be dismissed. I understand if selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard.
  5. I agree that, if hired, my employment shall not be for any specific duration and either the Company or I may terminate my employment relationship at any time, with or without cause and/or with or without prior notice. This express at-will acknowledgement supersedes any and all prior representations or understandings, whether written or oral, express or implied, between the Company and me.
  6. This is the entire agreement between myself and the Company regarding the length of my employment, and the reasons for termination of my employment, and this agreement supersedes any and all prior agreements regarding these issues. Oral representations or agreements made before or after my employment do not alter this Agreement.
  7. If any term or provision, or portion of this Agreement is declared void or unenforceable it shall be severed and the remainder of this Agreement shall be enforceable.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENT & AGREEMENT. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK A COMPANY REPRESENTATIVE BEFORE SIGNING.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENT & AGREEMENT. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK A COMPANY REPRESENTATIVE BEFORE SIGNING.

Signature of Applicant

Date