DATE (Month, Day, Year: ex. August 22, 2008)
POSITION APPLIED FOR
SALARY EXPECTATIONS
PERSONAL DATA
First, Middle, & Last Name
Street Address, City, State, Zip Code
Are you at least 18 years old?
Are there any days, shifts or hour you will not work? If yes, please explain.
When will you be able to start work?
Will you work overtime, if needed or required?
How did you learn of our company?
If referral, who were you referred by? What is your relationship to this person?
Have you ever applied or worked here before? If yes, provide dates.
Are you legally authorized to work in the United States?
Will you now or in the future require sponsorship for employment visa status?
Have you been convicted of a felony within the last 7 years? If yes, what was your felony and your Date of Conviction?
Have you been convicted the last 7 years of misappropriation of funds, embezzlement, or for other dishonest conduct, or an offense involving the use of a weapon, for burglary, robbery, breaking and entering or theft, or for physical assault or other violent crime?   If yes, which of these and what was your Date of Conviction?
DRIVING RECORD
Do you have a valid driver’s license? If so, please provide state, number, type of license (class) and expiration date.
Have you had any tickets?  If yes, please explain.
Has your license ever been suspended or revoked? If yes, please explain.
Do you have any DUI or DWI convictions? If yes, please state when you were convicted and explain.
RESIDENCES (Please provide your addresses of residence for the past 5 years beginning with the most recent address.)
Please provide Street Address, City, State, Zip Code  and  the Dates From  ______    To  ______
Please provide Street Address, City, State, Zip Code  and  the Dates From  ______    To  ______
Please provide Street Address, City, State, Zip Code  and  the Dates From  ______    To  ______
Please provide Street Address, City, State, Zip Code  and  the Dates From  ______    To  ______
Please provide Street Address, City, State, Zip Code  and  the Dates From  ______    To  ______
EDUCATION  (May or may not be considered depending on the job applied for.)
ELEMENTARY SCHOOL     COMPLETED?  Please provide Name, City, State  and dates Attended    From  ______    To  ______
MIDDLE SCHOOL     COMPLETED?  Please provide Name, City, State  and dates Attended    From  ______    To  ______
HIGH SCHOOL     COMPLETED?  Please provide Name, City, State  and dates Attended    From  ______    To  ______
COLLEGE / UNIVERSITY     COMPLETED?  Please provide Name, City, State  and dates Attended    From  ______    To  ______ as well as DEGREE ATTAINED, if any
Describe any other educational degrees, skills, training or experience you believe are relevant to the job applied for
EMPLOYMENT HISTORY (Please complete beginning with the most recent employer.)
# 1 - Company Name, Address, Telephone Number
Dates Employed:  From  ______    To  ______
Pay:  Start                  Last
Name of Supervisor(s)
State job titles and job duties
Reason(s) for Leaving
# 2 - Company Name, Address, Telephone Number
Dates Employed:  From  ______    To  ______
Pay:  Start                  Last
Name of Supervisor(s)
State job titles and job duties
Reason(s) for Leaving
# 3 - Company Name, Address, Telephone Number
Dates Employed:  From  ______    To  ______
Pay:  Start                  Last
Name of Supervisor(s)
State job titles and job duties
Reason(s) for Leaving
# 4 - Company Name, Address, Telephone Number
Dates Employed:  From  ______    To  ______
Pay:  Start                  Last
Name of Supervisor(s)
State job titles and job duties
Reason(s) for Leaving
# 5 - Company Name, Address, Telephone Number
Dates Employed:  From  ______    To  ______
Pay:  Start                  Last
Name of Supervisor(s)
State job titles and job duties
Reason(s) for Leaving
Please explain any gaps in your employment history
Have you ever been discharged or forced to resign?  If yes, please explain.
Were you given a performance evaluation in the last 12 months of active employment? If yes, what were your scores or results?
Have you signed any non-compete or non-solicit agreement with any other employer that might restrict you from working for this company? If yes, please explain.
MILITARY SERVICE (Please complete only if you served in the military.)
Please provide Branch of Service & Dates of Service:  From           To
Rank at Discharge:                       Date at Discharge:
Reason(s) for leaving
Describe any military skills, training or experience you believe are relevant to the job applied for
APPLICANT'S ACKNOWLEDGMENT
I certify that the answers given herein are true and complete to the best of my knowledge.  I understand that any misrepresentations, omissions of facts or incomplete answers in any application document will disqualify me from further consideration for employment.  I further understand that, if employed, any misrepresentations or omissions of facts in any application document will be cause for my dismissal at any time without prior notice.  I understand that, if employed, my employment is not for a specific term and may be terminated by me or the Company with or without notice or cause, at any time.  I further understand that no oral promise, custom business practice or other procedure constitute an employment contract or modification of the at-will employment relationship between me and the Company. I understand that applicants for certain positions may be required to qualify for employment based on additional employment criteria.  For example, I may be required to take job-related tests; take a driver’s examination; submit to a background investigation; take a pre-employment drug test.  If I am offered employment or start work before any required test is completed, my employment is contingent on a satisfactory result on all required tests. I acknowledge that this application will remain active for 30 days from this date.  If I have not heard from the company at the conclusion of this 30-day period, it is my responsibility to complete a new application if I still wish to be considered for employment by the Company.
Name (this serves as your signature)
E-mail
Home Telephone
Work Telephone
Cell Phone
Best Time To Call

Enter any other comments in the space provided below.

Before you press "Submit Application" below, you may want to print
 out this page just in case. That way if something happens, you can
just fax us the form at 305-278-7235 and not have to enter
everything all over again.

 

If a Form Confirmation pops up with all of your answers, that means it
 went through fine and we have received your application and you
 should be hearing from us within 24 hours. If it's the weekend
 or a holiday you will hear from us on Monday or the next
business day. You may call us at 305-978-2050
between 8:30 AM and 4:30 PM if you wish.

Good luck and thank you for applying!