APPLICATION FOR EMPLOYMENT

AN EQUAL OPPORTUNITY EMPLOYER & DRUG-FREE WORKPLACE
Position Applied For:
Referred By:

YOUR INFORMATION

First Name:
Middle Name:
Last Name:
Telephone:
Email:
Street Address:
City:  State:  Zip:
If employed and under 18 years of age,
can you furnish a work permit?
Have you filed an application
with this company before?
If yes, give date:
Have you ever been employed
with this company before?
If yes, give date:
Are you currently employed?
If yes, 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.)
On what date would you be available for work?
When are you available to work?
           

EDUCATION

HIGH SCHOOL

School Name:
Grade Completed:

VOCATIONAL TRAINING

School Name:
Years Completed:
Diploma:
Describe Course of Study:

COLLEGE/UNIVERSITY

School Name:
Years Completed:
Diploma:
Describe Course of Study:

GRADUATE/PROFESSIONAL

School Name:
Years Completed:
Diploma:
Describe Course of Study:
Describe Specialized Training, Apprenticeship, Skills, and Extra-Cirricular Activites:
Honors Received:
List professional, trade, business, or civic activities and offices held. (You may exclude memberships
that would reveal sex, race, religion, national origin, age, ancestry, disability or other protected status):

REFERENCES

Give the name, address, and telephone numbers of three references
who are not related to you and are not previous employers:
Name:
Address:
Phone:
Name:
Address:
Phone:
Name:
Address:
Phone:

EMPLOYMENT EXPERIENCE

Start with your present or last job. Include military service assignments and volunteer activities (You may exclude organization names that would reveal sex, race, religion, national origin, age, ancestry, disability, or other protected status.)
Employer:
Phone Number:
Address:
City:  State:  Zip:
Dates Employed From:  to  
Job Title:
Supervisor:
Hourly Rate/Salary Starting:  Final  
Work Performed:
Reason for Leaving:
Employer:
Phone Number:
Address:
City:  State:  Zip:
Dates Employed From:  to  
Job Title:
Supervisor:
Hourly Rate/Salary Starting:  Final  
Work Performed:
Reason for Leaving:
Employer:
Phone Number:
Address:
City:  State:  Zip:
Dates Employed From:  to  
Job Title:
Supervisor:
Hourly Rate/Salary Starting:  Final  
Work Performed:
Reason for Leaving:
Employer:
Phone Number:
Address:
City:  State:  Zip:
Dates Employed From:  to  
Job Title:
Supervisor:
Hourly Rate/Salary Starting:  Final  
Work Performed:
Reason for Leaving:

SPECIAL SKILLS AND QUALIFICATIONS:

Summarize special skills and qualifications acquired from employment experience or education.

NOTES

RESUME (OPTIONAL)

  

APPLICANT'S STATEMENT

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 360 days. If I wish to be considered for employment beyond this time period, I understand that I need to inquire as to whether or not applications are being accepted at that time.

I understand that neither this document nor any offer of employment from the employer constitutes an employment contract unless a specific document to that effect is executed by the employer and me in writing.

In the event of employment, I understand that false 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 of the employer.
**A representative from J&B will contact you only when a position is open for which you are qualified.**