PERSONAL INFORMATION
Ex: 1622 W. Jackson St. Muncie, IN, 47303
ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED IN THIS COUNTRY BECAUSE OF VISA OR IMMIGRATION STATUS?
EMPLOYMENT INFORMATION
ARE YOU EMPLOYED NOW?
IF YES, MAY WE INQUIRE WITH YOUR PRESENT EMPLOYER?
EVER APPLIED TO THIS COMPANY BEFORE?
CAN YOU WORK HOLIDAYS?
CAN YOU WORK NIGHTS?
CAN YOU WORK WEEKENDS?
EDUCATION
DID YOU GRADUATE?
DID YOU GRADUATE?
FORMER EMPLOYERS
Job #1
Job #2
Job #3
Job #4
MILITARY
HAVE YOU BEEN A MEMBER OF THE US MILITARY?
IF YES OR ACTIVE, PLEASE FILL OUT BELOW
REFERENCES
GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.
FINAL
IN CASE OF EMERGENCY NOTIFY

"I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY.I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRITING SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING."

DO YOU AGREE?
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APPLICATION FOR EMPLOYMENT

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