Job Application

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All applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical/mental disability, medical condition, military/veteran status, genetic information, marital status, ethnicity, citizenship or immigration status, or any other protected classification, in accordance with applicable federal, state, and local laws. By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our customers and contributing to the financial success of the organization, its clients, and its employees. Equal access to programs, services, and employment is available to all qualified persons. Those applicants requiring accommodation to complete the application and/or interview process should contact a management representative.

Position(s) Applied For*

Date of Interview*

Full Name*

Street Address*

City*

State*

Zip*

Cell Phone Number*

Alt. Phone Number

Email*

Desired Wage Expectation*

When Can You Start Work?*

Employment Experience

Name of Employer #1

Supervisor

May We Contact?

Phone Number

Dates Employed (Month/Year)

Reason For Leaving

Name of Employer #2

Supervisor

May We Contact?

Phone Number

Dates Employed (Month/Year)

Reason For Leaving

Name of Employer #3

Supervisor

May We Contact?

Phone Number

Dates Employed (Month/Year)

Reason For Leaving

Education

High School

School Name

Diploma/Degree (yes/no)

Area of Study/Major

Specialized training, skills, or extracurricular activities

College/University

School Name

Diploma/Degree (yes/no)

Area of Study/Major

Specialized training, skills, or extracurricular activities

Graduate/Professional School

School Name

Diploma/Degree (yes/no)

Area of Study/Major

Specialized training, skills, or extracurricular activities

Other

School Name

Diploma/Degree (yes/no)

Area of Study/Major

Specialized training, skills, or extracurricular activities

Applicant Statement and Agreement

If there is anything that you do not understand, please ask. In the event of my employment with the company, I understand that I am required to comply with all rules and regulations of the company.

If hired, I understand and agree that my employment with the company is at will and that neither I nor the company is required to continue the employment relationship for any specific term. I further understand that the company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.

I Understand

I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I Understand

I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration law requires me to complete an I-9 Form in this regard.

I Understand

I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed, and the remainder of this Agreement shall be enforceable.

I Understand

Note: We comply with the Americans with Disabilities Act and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions.

My signature attests to the fact that I have read, understand, and agree to all the above terms.

E-Signature

Todays Date

Job Application

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