2574 North Campbell Avenue
Phone: 520-795-2665
FAX: 520-207-6044

Application for Employment

Personal Information

Date:

Name Last: First: Middle: Social Security Number:

Present Address, Street: City: State: Zip:

Permanent Address, Street: City: State: Zip:

Phone Number:

Are you under 18 years of age? If yes, list birth date

Have you ever been employed by this company before?

Where? When Manager's Name

Are you eligible to work in the United States?

If hired do you have a reliable means of transportation to get to work?
Explain:

What interests, hobbies, or extra curricular activities do you have (exclude those that are religious or ethnic in nature):


Have you ever been convicted of a felony or misdemeanor other than a traffic violation?

If yes, explain:

Employment Desired

Position applying for: Full or Part Time

Date available: Rate of pay desired:

Please indicate below the days and hours on those days that you would be available to work:
MondayHours:
TuesdayHours:
WednesdayHours:
ThursdayHours:
FridayHours:
SaturdayHours:
SundayHours:

 

Employment History

(List below former employers, starting with last one first)
Date, Month, YearEmployer's Name, Address
Supervisors Name/Phone
Job Title and DutiesSalary/WageReason for Leaving
From: 
To:     
From: 
To:     
From: 
To:     
From: 
To:     
May we contact the past and/or present employers listed above? If no, then indicate those you do not want us to contact.


IN CASE OF EMERGENCY, NOTIFY:
Name: Address: Phone Number:

Education

SchoolingName and Location of SchoolGradeYearGPAGraduate
High School
College
Trade/Business
Other (specify)

References

Give the names of persons not related to you as references, whom you have known at least 1 year
 NameAddressPhone
Number
Years
Acquainted
Personal/Business
1.
2.
3.
Are you known to schools/references by another name? If yes, please indicate the name(s):


1.I authorize investigation of all statements contained on this application except where I have requested on this form that no investigation be made.
2.I understand that misrepresentation of omission of facts called for is cause for dismissal and that my employment is substantially dependent on truthful answers to the foregoing inquires.
3.I understand that nothing contained in this employment application or in the granting of an interview is intended to nor does it create an employment contract between the company and myself for either employment or the providing of any benefit. In the event that an employment relationship is established, I understand that I have the right to terminate my employment at any time for any reason or no reason, and the Company retains the same right regarding the discontinuation of my employment.
By checking this box, I acknowledge all information to be accurate and agree to the above terms.


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