Date Position applied for First Name Last Name M.I. Address City State Zip Code Email Telephone When can you start? Desired Wage $ Are you authorized to work in the United States? (You may be required to provide documentation.) YesNo Are you looking for full-time employment? YesNo If no, what hours are you available? Education High School (Name and Location) Year Major/Degree College (Name and Location) Year Major/Degree Post-College/Other Training In addition to your work history, do you have other skills, qualifications, or experience that we should consider? Employment History (Start with most recent employer) Company Name Address Telephone Date Started Date Ended Starting Position Starting Wage Ending Position Ending Wage Name of Supervisor May We Contact This Person? YesNo Responsibilities Reason For Leaving Company Name Address Telephone Date Started Date Ended Starting Position Starting Wage Ending Position Ending Wage Name of Supervisor May We Contact This Person? YesNo Responsibilities Reason For Leaving Company Name Address Telephone Date Started Date Ended Starting Position Starting Wage Ending Position Ending Wage Name of Supervisor May We Contact This Person? YesNo Responsibilities Reason For Leaving Attach additional information if necessary.I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application may lead to termination of my employment. This company is hereby authorized to make any investigations of my prior educational and employment history. I understand that employment at this company is “at will,” which means that either I or the company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing. Attach additional information if necessary. Signature Date