Employment Application

AN EQUAL OPPORTUNITY EMPLOYER
Please fill out the form.
PERSONAL DATA
Name:
Last: First: Middle:
Other names you have used which may be necessary to verify previous employment and education :
Last: First: Middle:
Current Address
Address: Zip: Phone:
Permanent Address
Address: Zip: Phone:
Daytime Phone: Email Address:
Can you provide documentation to verify your identity and legal authority to work in the United States?
Have you ever been convicted of a misdemeanor, a felony or convicted in a military court martial? If yes, give the date and explain.
If Yes, explain:
(A conviction will not necessarily disqualify you from employment. “Convicted” includes a finding of guilt by a judge/jury, a plea of guilty or “no contest.” You also agree to promptly notify the Company if you are later convicted of a misdemeanor or a felony.)
POSITION APPLYING FOR
Position:
Type of work desired:
Check Days Available:





Hours Available in Days:    in Evenings:             Date Available:
Name of referral source: 1 2
Wage or salary acceptable: $   per hour    $ per year
Have you ever been employed by our COMPANY?
If Yes, when?   
EDUCATION AND TRAINING
Circle last year completed in Grade, Trade, or High School:

in Tech. College:
Graduate:
List all high schools, business or trade schools, and colleges attended :
Name and location Major / Minor Degree Granted
  
  
  
List extracurricular activities (include offices held, scholarships, awards, honors, sports, etc.) You are not required to list activities which may reveal your race, age, religion, sex, national origin, marital status, sexual orientation, or any disability.
List:
EMPLOYMENT RECORD
Please list employers and military service. If you list any employment prior to 5 years from today’s date, do not list the dates of employment. Instead, for all employment more than 5 years from today, list the total number of years and months you were consecutively employed by each employer (i.e., 2 years, 5 months).
CURRENT / MOST RECENT
Employer: From: To:
Address: Salary: Tel. #:
Position: Supervisor and Title:
Summary of Duties:
Reason for leaving : Hours worked per week:
FIRST PREVIOUS
Employer : From: To:
Address: Salary: Tel. #:
Position: Supervisor and Title:
Summary of Duties:
Reason for leaving : Hours worked per week :
SECOND PREVIOUS
Employer : From: To:
Address: Salary: Tel. #:
Position: Supervisor and Title :
Summary of Duties:
Reason for leaving : Hours worked per week:
THIRD PREVIOUS
Employer : From: To:
Address: Salary: Tel. #:
Position: Supervisor and Title:
Summary of Duties:
Reason for leaving : Hours worked per week:
Have you ever been discharged (fired) or asked to resign from any employment?
If yes, give details of each occurrence.
If you were self-employed or unemployed for three consecutive months or more within the past five years, please indicate the dates and provide an explanation below.
May we contact all of the above employers for references?
Employer: Reason:
Employer: Reason:
If no, list the employers not to be contacted and give reason.
Please list membership(s) in professional or civic organizations. You are not required to list any which reveal your race, age, religion, sex, national origin, marital status, sexual orientation, or disability.
If you need additional space to complete any of the previous items, please attach a separate sheet to this application form.
IMPORTANT – READ BEFORE SUBMITTING
I authorize Eighth Floor Promotions (EFP) to investigate the information contained in this application and release it (and its employees and agents) from any and all liability for seeking information and opinions on me. I authorize all employers, educational institutions, entities, and persons listed in this application to provide information about me and hereby release them from all liability for issuing such information. I hereby waive any privilege I have to such information.

I certify that the information I provided the EFP in this application and during the hiring employment process is true and complete. I understand and acknowledge that any false, misleading, or incomplete information in the application or during the hiring process may result in rejection of my application or, if I have been hired, immediate termination of employment. I agree that EFP shall not be liable in any respect if I am not hired or if my employment is terminated as a result of providing such false, misleading or incomplete information.

I understand that if employed I will be required to abide by all the rules and regulations of EFP including applicable safety rules, and I agree to use such protective clothing and devices as may be required by EFP.

I understand that nothing contained in this employment application or in the granting of an interview, and no EFP policies, procedures, or handbooks that I might receive if I am hired, are intended to create an employment contract between EFP and me for either employment or for the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon EFP unless made in writing. If an employment relationship is established, I understand that I have the right to terminate my employment at any time for any reason or no reason, with or without cause, and with or without prior notice, and that EFP retains a similar right. I also understand that if I am hired I will be required to sign a confidentiality statement and conflict of interest statement as a condition of my employment.

I hereby acknowledge that I have read and understood all of the information above written and agree to the terms therein.
 
2552291\1 (Rev. 8.21.01)