Job Application - Joe Rushing

Last Name

First Name

M.I.

Date

Street Address

City

State

Zip

Phone

Date of Birth

SSN

Drivers License # & State

Date Available

Desired Salary

Are you a citizen of the United States?

Yes No

If no, are you authorized to work in the U.S.?

Yes No

Have you ever worked for this company?

Yes No

If so, when?

Have you ever been convicted of a felony?

Yes No

If so, explain.

Have you ever been convicted of a misdemeanor?

Yes No

If so, explain.

Have you had any driving violation in the last 2 years?

Yes No

If so, explain.

EDUCATION

Highest Level of Education

High School College Other

School Address

Dates Attended

Did you graduate?

Yes No

Degree

PLEASE LIST 3 PROFESSIONAL REFERENCES

Reference #1

Full Name

Relationship

Company

Phone

Reference #2

Full Name

Relationship

Company

Phone

Reference #3

Full Name

Relationship

Company

Phone

PREVIOUS EMPLOYMENT

Company #1

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

Dates (From - To)

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes No

Company #2

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

Dates (From - To)

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes No

Company #3

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

Dates (From - To)

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes No

MILITARY SERVICE

Branch

Dates (From - To)

Rank at Discharge

Type of Discharge

If other than honorable, explain

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Describe any job-related training received in the United States Military.

List Professional, trade, business or civic activities and offices held.

Best Time to Contact You Is

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. If the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Signature

Date

Uploade Cover Letter