Position Applied For
Employment History
Company        Supervisor        Position           Dates EmployedReason for Leaving
Are you a U.S. Citizen or otherwise legally able to work in the U.S. ?
Are you currently Employed?
Have you ever been convicted of a felony? If yes, please explain and give dates
Have you been convicted of a misdemeanor in the last five years? If yes, please explain and give dates
The facts set forth in my application for employment are true and complete. I understand that if I am employed, false statements on this application shall be sufficent cause for dismissal. I agree that all individuals supplying inforation about me, for referene purposes, are released from liability. If a job opportunity is offered, I shall comply with all uniform requirements. I understand that job duties often include opening and closing sidework and cleainng duties.
Selection of employees shal be based on occupational qualifications, education and character without regard to race, sex, creed color, national origin, age or handicap.
Electronic Signature Indicating Acceptance of Above Terms