Employee Application Form

Please complete all portions of this application. Entering “See Resume” will not be acceptable.

    * is required field.

    Have you ever worked for this Company before?*

    If yes, please give dates and position

    If hired, can you furnish proof that you are over 18 years of age?*
    If you are under age 18, can you furnish a work permit?
    Can you, after employment, submit verification of your legal right to work in the United States?*
    (Proof of citizenship or immigration status will be required upon employment e.g., U.S. Passport, birth certificate, Green Card, etc.)
    Are you available to work*:

    If you checked "Temporary", please tell us duration.

    Referral Source*:

    The California Salary Privacy Act prohibits employers from asking applicants about their prior salary or using salary history to determine whether to offer employment or what salary to offer. This application does not request prior salary or benefits information.

    WORK EXPERIENCE

    Please list the names of your present or previous employers beginning with more recent position.

    May we contact your present employer?*:

    If no, please explain

    WORK EXPERIENCE (contd.)

    EDUCATION

    High School: Select years completed.
    Trade/ Vocational School: Select years completed.
    College: Select years completed.
    Graduate School: Select years completed.

    Special skills and qualifications and any honors received:
    Summarize special skills and qualifications acquired from employment or other experience. State any additional information you feel may be useful to us in considering your application.

    Are you capable of satisfactorily performing the essential job duties required of the position for which you are applying?*

    PROFESSIONAL LICENSES AND CERTIFICATIONS

    Type, State, Issue Date, Expiration Date, Number (include Driver's License, if job related)

    Indicate languages other than English that you speak, read, and/or write.
    The company, in compliance with California State Law, maintains a directory of employees who are able to translate or sign.

    Speak:

    Read:

    Write:

    PERSONAL REFERENCES

    Please list persons who know you well, not previous employers or relatives

    to the
    APPLICANT'S STATEMENT AND AGREEMENT for employment.