P

APPLICATION FOR EMPLOYMENT

Personal Information

 

Last Name:
First:
MI:

E-Mail Address:
SS #:

Present Street Address:

City:
State:
Zip:

Phone:
Referred By:

Employment Desired


Position Desired:

Date you can start:
Salary Desired:

Currently Employed ?
If yes, may we contact your current employer ?

Employer:

Employer's Phone:

Ever Applied To Handy Before?
When?

Education


*THE AGE DISCRIMINATION IN EMPLOYMENT ACT OF 1967 PROHIBITS DISCRIMINATION ON THE BASIS OF AGE WITH RESPECT TO INDIVIDUALS WHO ARE AT LEAST 40 YEARS OF AGE. YOU DO NOT HAVE TO ENTER DATES OR YEARS ATTENDED SCHOOL IN COLUMN BELOW.

Name and Location of School
Years Attended*
GRAMMAR
SCHOOL
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS, OR OTHER SCHOOL


Degree Awarded or Highest Grade Completed
Subjects Studied
GRAMMAR
SCHOOL
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS, OR OTHER SCHOOL

General


Subjects of Special Study or Research Work:

List any Special Training (E.G. Mechanic, Electrician,
Truck Driver, ETC.):

Are you at Least 18 Years of Age?

U.S. Military Service:
Rank:

Type of Discharge:

Present Membership in Guard or Reserves

Have you ever been Convicted of a Felony?**

Can you Provide Documentation of your Citizenship or Residence Status?

Some of the Jobs you are Applying for Require Strenuous Physical Labor. Is there Anything which would Prevent you from Frequently Lifting more than 50 LBS or being Subject to Routine Cuts, Bruises, and Abrasions?

In Case of Emergency, Notify:

Address:
Phone Number:

**AN AFFIRMATIVE ANSWER WILL NOT NECESSARILY DISQUALIFY YOU FOR EMPLOYMENT.

Employment History


List Current Employer First.

Company Name, Address, Phone

Employed From:
Employed Until:

Salary:
Position:

Reason For Leaving:

Company Name, Address, Phone

Employed From:
Employed Until:

Salary:
Position:

Reason For Leaving:


Company Name, Address, Phone

Employed From:
Employed Until:

Salary:
Position:

Reason For Leaving:

References


GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.

Name:
Address:

Business:
Phone:
Years Known:


Name:
Address:

Business:
Phone:
Years Known:


Name:
Address:

Business:
Phone:
Years Known:




I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. I UNDERSTAND THAT ANY MISREPRESENTATION OR OMISSION OF FACTS CALLED FOR IS CAUSE FOR DISMISSAL, AND MAY EFFECT ANY WORKER'S COMPENSATION CLAIM I MIGHT MAKE. I MAY, REGARDLESS OF ANYTHING TO THE CONTRARY, BE TERMINATED AT WILL AND AT ANY TIME WITHOUT ANY PREVIOUS NOTICE FROM THE COMPANY. I FURTHER UNDERSTAND THAT I WILL REMAIN AN AT WILL EMPLOYEE AT ALL TIMES AND MY STATUS AS AN AT WILL EMPLOYEE MAY ONLY BE CHANGED IN WRITING BY THE PRESIDENT OF THE COMPANY.

I HAVE READ AND UNDERSTAND THE ABOVE AGREEMENT.

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