Employment Application
 

Name  
Street address
City, State, ZIP
Home phone
Alternate phone
Have you worked for us before?
Position you are applying for?
Date available?
Rate of pay expected?
Referred by? Newspaper Employee On my own Agency
School Other
Are you available to work every day of
the week? (We will attempt to reasonably
accommodate employees who require
certain hours or days off because of religious beliefs or practices.)
 		    Yes No
Are you authorized to accept employment in the United States? (Successful applicants will be required to prove identity and eligibility for employment.)
 		     Yes No
Relatives and friends - Some positions may not be held by certain individuals to avoid the possibility of conflict of interest. Qualified relatives and friends are eligible for employment except in those unusual situations. For example, where they would be placed in a supervisor - subordinate relationship. Do you have any friends or relatives who currently work for us?  Yes No
 
Qualifications - Please list ALL education, training and specialized experience that you feel would help you perform the work for which you are applying. Include degrees, licenses and relevant education or training and dates and places of attendance.

 
Criminal Record - Conviction of a crime is not an automatic bar to employment. Factors such as the nature and gravity of the crime, the length of time since the last conviction and/or completion of any sentence and the nature of the job for which you have applied, will be considered. Washington applicants: Do not list any conviction for which the date of conviction or prison release, whichever is more recent, is more than seven years old.
Have you ever been convicted, pled guilty or no contest or forfeited bond or bail for any crime other than traffic convictions?  Yes   No  If so, give details:

 
Driving positions - If the position applied for involves driving, have you ever been convicted, pled guilty or no contest or forfeited bond or bail for any traffic violations in the past three years? Yes No
If yes, give details:

 
In case of emergency, notify:
Employment Experience
 
Present or last employer
Phone
Their address
Supervisor
Job title
Reason for leaving
Hire date
Date left
Starting pay
Final pay
   
Previous employer
Phone
Their address
Supervisor
Job title
Reason for leaving
Hire date
Date left
Starting pay
Final pay
   
Previous employer
Phone
Their address
Supervisor
Job title
Reason for leaving
Hire date
Date left
Starting pay
Final pay
   
Previous employer
Phone
Their address
Supervisor
Job title
Reason for leaving
Hire date
Date left
Starting pay
Final pay
   
Previous employer
Phone
Their address
Supervisor
Job title
Reason for leaving
Hire date
Date left
Starting pay
Final pay
   
Verification and Signature
1. I authorize the investigation of all matters which the company deems relevant to my qualifications for employment, including all statements made in this application and in any attachments or supporting documents. I authorize you to request and receive such information and I release from all liability any persons, such as former supervisors or employers supplying it. I also release you from all liability which might result from making the investigation.
2. I certify that the facts and information in this application and in any attachments or supporting documents are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation or omission, as well as any misleading statements or omissions, generally will result in denial of employment or immediate termination, regardless of when and how discovered. I also understand that providing information other than that requested on this application will result in my disqualification of this application.
3. I understand that I may be required to submit to employment physical or other professional examinations, medical Inquiries and/or urinalysis tests for the presence of drugs and/or alcohol. I agree to such examinations, inquiries and/or lasting at the Company's expense. I authorize release of the results to the Company and their use to evaluate my suitability for employment. I also release the Company from all liability arising out of or connected with any examinations, inquiries and or testing.
4. I understand that I may resign or be terminated, without cause or notice, at any time, unless otherwise stated in an employment contract. I also understand that _______________________is the only person who will ever have the authority to agree to any other terms and/or to enter into such contracts and that all such agreements for other terms of employment or contracts must be in writing and signed by both parties. I also understand that unless otherwise stated in an employment contract, the Company may change, withdraw and interpret other policies (including wages, hours and working conditions) as it deems appropriate.
5. This original application for employment will only be considered for 30 days.
6. I have read each of these statements. I have also reviewed all of the information provided in this application and in any supporting documents.
Yes    No 
If hired, we will have you sign this document along with the other paperwork.