First Management Application For Employment

(*) Required Fields   - If a Form Field does not apply to you please use N/A for Not Applicable
* First Name
* Middle Name
* Last Name
* Address 1:
  Address 2:
* City:
* State:
*Zip Code:
* Telephone: XXX-XXX-XXXX
* Email Address:
* Are you 18 years of age or older?   Yes  No
* If hired, can you provide written evidence that you are authorized to work in the U.S.?   Yes  No

Education

Type Name/Location Course of Study # Years
Completed		 Degree/Diploma
* Elementary & Jr. High  Yes  No
* High School  Yes  No
* College  Yes  No
* Technical or Other  Yes  No

Employment Record

Company Name and address Kind of Work Date Started/Left Rate of Pay Reason for Leaving
* 1.
* 2.
* 3.
* 4.

U.S. Military Service

* Branch of Service:     * From  * To 
* Rank and Type of Service:
* Training and Experience Received:

References (Do Not Include Relatives)

Name / Occupation / Years Known / Address
* 1.
* 2.
* 3.

Employment

* Type of Work Desired:
* Salary Desired:
* How Were You Referred to Our Organization?
* Do You Have Any Relatives Who Are Employed By This Organization?    Yes  No
* Please Specify:
* Is there any information we would need about your name, or use of another name, for us to be able to check your work record?    Yes  No
* Please Specify:
* Please list any additional information that relates to your ability to perform the job for which you have applied
such as licenses, professional memberships, hobbies, etc.
APPLICANT'S STATEMENT I understand that the employer follows an “employment at will” policy, in that I or the employer may terminate my employment at any time, or for any reason consistent with applicable state or federal law; this “employment at will” policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by the chief operating officer of this organization. I understand that this application is not a contract of employment. I understand that federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity; failure to submit such proof will result in denial of employment. I understand this application will be active for a period of one year; after that time, if I wish to be considered for employment, I must submit a new application. I understand that the employer will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named therein, except my current employer if so noted, to provide any information requested about me, and I release them from all liability for damage in providing this information. I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment.
* I agree to these terms and understand that by submitting this form online constitutes my electronic signature, and my electronic submission of this application shall be legally binding, such transaction shall be considered authorized by me, and the same terms that apply to a signed paper application will apply to this electronically submitted application.
* Date:  mm/dd/yyyy