Employment Application

Employment Application

It is the policy of this company to provide equal employment opportunities to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, physical or mental handicap or veteran status.

	POSITION SPECIFICATIONS
POSITION APPLYING FOR
HOW DID YOU HEAR ABOUT THIS JOB?
WHAT HOURS ARE YOU WILLING TO WORK?
WOULD YOU BE ABLE TO WORK ON WEEKENDS?	YES NO
ARE YOU WILLING TO TRAVEL FOR THE JOB?	YES NO
WHEN WOULD YOU BE ABLE TO START?
DESIRED HOURLY RATE
DO YOU HAVE ANY LAND SURVEYING EXPERIENCE?	YES NO - IF YES, PROVIDE A GENERAL EXPLANATION:
INTERESTED IN:	FULL-TIME EMPLOYMENT PART-TIME EMPLOYMENT

	PERSONAL INFORMATION
FIRST NAME
MIDDLE NAME
LAST NAME
STREET ADDRESS
CITY
STATE
ZIP
MAILING ADDRESS
CITY
STATE
ZIP
TELEPHONE
FAX
CELL
EMAIL ADDRESS
SOCIAL SECURITY NO
DRIVERS LICENSE NO
DRIVERS LICENSE STATE
CITIZENSHIP	I AM A U.S. CITIZEN OR OTHERWISE AUTHORIZED TO WORK IN THE US ON AN UNRESTRICTED BASIS: YES NO IF APPLICABLE, PLEASE LIST YOUR VISA TYPE, VISA# AND EXPIRATION:
CONVICTION	HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES NO IF YOU ANSWERED YES, PLEASE EXPLAIN:
MILITARY SERVICE	HAVE YOU EVER SERVED IN THE U.S. MILITARY? YES NO IF YES, PLEASE PROVIDE THE FOLLOWING INFORMATION: BRANCH OF SERVICE: RANK AT TIME OF SEPARATION: I SERVED FROM TO SPECIAL HONORS:

	EMPLOYMENT HISTORY
PRESENT/MOST RECENT	EMPLOYER (#1)
ADDRESS
POSITION
DUTIES
DATES	FROM TO
SUPERVISOR NAME
SUPERVISOR TITLE
MAY WE CONTACT?	YES NO
REASONS FOR LEAVING

PRIOR	EMPLOYER (#2)
ADDRESS
POSITION
DUTIES
DATES	FROM TO
SUPERVISOR NAME
SUPERVISOR TITLE
MAY WE CONTACT?	YES NO
REASONS FOR LEAVING

PRIOR	EMPLOYER (#3)
ADDRESS
POSITION
DUTIES
DATES	FROM TO
SUPERVISOR NAME
SUPERVISOR TITLE
MAY WE CONTACT?	YES NO
REASONS FOR LEAVING

PRIOR	EMPLOYER (#4)
ADDRESS
POSITION
DUTIES
DATES	FROM TO
SUPERVISOR NAME
SUPERVISOR TITLE
MAY WE CONTACT?	YES NO
REASONS FOR LEAVING

	EDUCATION
HIGH SCHOOL
ADDRESS
DID YOU GRADUATE?	YES NO IF NO, DID YOU RECEIVE YOUR GED? YES NO
ATTENDED	FROM TO
HONORS OR AWARDS

TECHNICAL OR VOCATIONAL SCHOOL
ADDRESS
DID YOU GRADUATE?	YES NO
ATTENDED	FROM TO
DEGREE OR CERTIFICATION
SPECIALTY
HONORS OR AWARDS

COLLEGE OR UNIVERSITY
ADDRESS
DID YOU GRADUATE?	YES NO
ATTENDED	FROM TO
DEGREE
MAJOR
HONORS OR AWARDS

COLLEGE OR UNIVERSITY
ADDRESS
DID YOU GRADUATE?	YES NO
ATTENDED	FROM TO
DEGREE
MAJOR
HONORS OR AWARDS


	I hereby certify that my answers and assertions set forth in this application are true and complete to the best of my knowledge. If I am employed, I understand that any false statements on this application shall be considered sufficient cause for my dismissal. I hereby authorize this company to investigate any aspect of my prior educational and employment history. Furthermore I understand that if I am hired, employment with this company is "at will," which means that either the company or I can terminate my employment for any reason not prohibited by state or federal law. SIGNATURE DATE

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