Print, fill in questions and fax to 239-288-7354
APPLICATION FOR EMPLOYMENT
ALL POTENTIAL EMPLOYEES ARE EVALUATED WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER,
NATIONAL ORIGIN, AGE, MARITAL OR VETERAN STATUS, THE PRESENCE OF A NON-JOB
RELATED HANDICAP OR ANY OTHER LEGALLY PROTECTED STATUS.
Name_____________________________________________________________________Phone Number:_____________________________________________________
Email Address: __________________________________________________________________________
Position Sought:________________________________________How did you learn about the position? _____________________________________________
Social Security Number:___________________________________________________________________
Do you have a Driver's License? [ YES ] [ NO ]
Do you have reliable transportation to work? [ YES ] [ NO ]
Driver’s license number ___________________________ State of issue _______ Expiration date ______________________
On what date would you be available for work? ____________________ Desired Wage/Salary $_____________hr/mo
Are you a U.S. citizen, or are you otherwise authorized to work in the U.S. without any restriction? [ ] Yes [ ] No
Have you ever been convicted of a felony? [ ] Yes [ ] No
If yes, please describe circumstances:
_______________________________________________________________________________________________________
Have you ever been involuntarily terminated or asked to resign? [ ] Yes [ ] No
If yes, please describe circumstances:
________________________________________________________________________________________________________
If selected for employment, are you willing to submit to a pre-employment drug screening test? [ ] Yes [ ] No
EDUCATION
School Name_____________________________________________________________________________________________
Years Attended_____________________________________________________________________________________________
Degree Received____________________________________________________________________________________________
Other training, certifications, or licenses held:_____________________________________________________________________
List other information pertinent to the employment you are seeking ___________________________________________________
EMPLOYMENT
(Most Recent First.)
1. Employer______________________________________________________________ Job Title_______________________________________
Dates Employed____________________________
Address_______________________________________________________________________ City___________________ State________
Phone___________________________ Supervisor_________________________________
Starting Salary____________________________hr/mo
Ending Salary______________________________hr/mo
Duties Performed _____________________________________________________________________________________
Reason for Leaving ____________________________________________________________________________________
2. Employer______________________________________________________________ Job Title_______________________________________
Dates Employed____________________________
Address_______________________________________________________________________ City___________________ State________
Phone___________________________ Supervisor_________________________________
Starting Salary____________________________hr/mo
Ending Salary______________________________hr/mo
Duties Performed _____________________________________________________________________________________
Reason for Leaving ____________________________________________________________________________________
3. Employer______________________________________________________________ Job Title_______________________________________
Dates Employed____________________________
Address_______________________________________________________________________ City___________________ State________
Phone___________________________ Supervisor_________________________________
Starting Salary____________________________hr/mo
Ending Salary______________________________hr/mo
Duties Performed _____________________________________________________________________________________
Reason for Leaving ____________________________________________________________________________________
ACKNOWLEDGMENT
AND AUTHORIZATION
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 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my applicator or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Signature of Applicant________________________________________________________________________________DATE_______________________
APPLICATION FOR EMPLOYMENT
ALL POTENTIAL EMPLOYEES ARE EVALUATED WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER,
NATIONAL ORIGIN, AGE, MARITAL OR VETERAN STATUS, THE PRESENCE OF A NON-JOB
RELATED HANDICAP OR ANY OTHER LEGALLY PROTECTED STATUS.
Name_____________________________________________________________________Phone Number:_____________________________________________________
Email Address: __________________________________________________________________________
Position Sought:________________________________________How did you learn about the position? _____________________________________________
Social Security Number:___________________________________________________________________
Do you have a Driver's License? [ YES ] [ NO ]
Do you have reliable transportation to work? [ YES ] [ NO ]
Driver’s license number ___________________________ State of issue _______ Expiration date ______________________
On what date would you be available for work? ____________________ Desired Wage/Salary $_____________hr/mo
Are you a U.S. citizen, or are you otherwise authorized to work in the U.S. without any restriction? [ ] Yes [ ] No
Have you ever been convicted of a felony? [ ] Yes [ ] No
If yes, please describe circumstances:
_______________________________________________________________________________________________________
Have you ever been involuntarily terminated or asked to resign? [ ] Yes [ ] No
If yes, please describe circumstances:
________________________________________________________________________________________________________
If selected for employment, are you willing to submit to a pre-employment drug screening test? [ ] Yes [ ] No
EDUCATION
School Name_____________________________________________________________________________________________
Years Attended_____________________________________________________________________________________________
Degree Received____________________________________________________________________________________________
Other training, certifications, or licenses held:_____________________________________________________________________
List other information pertinent to the employment you are seeking ___________________________________________________
EMPLOYMENT
(Most Recent First.)
1. Employer______________________________________________________________ Job Title_______________________________________
Dates Employed____________________________
Address_______________________________________________________________________ City___________________ State________
Phone___________________________ Supervisor_________________________________
Starting Salary____________________________hr/mo
Ending Salary______________________________hr/mo
Duties Performed _____________________________________________________________________________________
Reason for Leaving ____________________________________________________________________________________
2. Employer______________________________________________________________ Job Title_______________________________________
Dates Employed____________________________
Address_______________________________________________________________________ City___________________ State________
Phone___________________________ Supervisor_________________________________
Starting Salary____________________________hr/mo
Ending Salary______________________________hr/mo
Duties Performed _____________________________________________________________________________________
Reason for Leaving ____________________________________________________________________________________
3. Employer______________________________________________________________ Job Title_______________________________________
Dates Employed____________________________
Address_______________________________________________________________________ City___________________ State________
Phone___________________________ Supervisor_________________________________
Starting Salary____________________________hr/mo
Ending Salary______________________________hr/mo
Duties Performed _____________________________________________________________________________________
Reason for Leaving ____________________________________________________________________________________
ACKNOWLEDGMENT
AND AUTHORIZATION
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 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my applicator or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Signature of Applicant________________________________________________________________________________DATE_______________________
