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APPLICATION FOR EMPLOYMENT

Date:

PERSONAL INFORMATION

First Name:
Last Name:
Middle Name:
Street Address: City: State:
Zip:

Home Phone:
Cell Phone:

Are you a 18 years or older?


Are you prevented from lawfully becoming employed in this country because of visa or immigration status?

EMPLOYMENT DESIRED

Position:
Food Service
Housekeeping
1st Shift Front Desk
2nd Shift Front Desk
3rd Shift Front Desk
Maintainance
CNA/Nursing
Administration
Other:

Available Start Date:

Salary Desired:

Are you employed now?:
If so, may we contact present employer?:

Have you ever applied to our company before?:
When?:

Referred By:

EDUCATION

SchoolsName?No. of Years Attendend GraduatedSubjects Studied
Grammer School:
High School:
College:
Trade/Business School:

GENERAL

Subjects of special study or research work:

Special Skills:

Activities: (Civic, Athletic, Etc.):
Excludes organizations, the name of which indicates race, creed, sex, age, marital status, color, or nation of orgin of its members.

U.S. Military or Naval service:
Rank:
Present membership in Nat'l Guard or Reserves?:

Former Employers

(List below last three employers, starting with last one first.)
Name/Address of Employer:
From: To: Present
Salary: Position:
Reason For Leaving:

Name/Address of Employer:
From: To: Present
Salary: Position:
Reason For Leaving:

Name/Address of Employer:
From: To: Present
Salary: Position:
Reason For Leaving:

Which of these jobs did you like the best?

What did you like most about this job?:

References:

Give the names of three persons not related to you, whom you have known at least one year.
NamePhone #CompanyYrs. Acquainted

In Case of Emergency, Notify:
Name: Phone: Address:
"I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRITING AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING."
Please type your FULL NAME and today's date:

Name: Date:


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