Employment Application
Personal Data
Position(s) applying for * :
Referral source: Advertisement
Employee
Relative
Walk-In
Employment Agency
School
Other
Name of source (if applicable):
Your name * :
Your Email * :
Your Telephone number * :
Street * :
City * :
State * :
Zip * :
If you are under age 18 and it is required, can you furnish a work permint: Yes No
Have you submitted an application before: Yes No
If so, when:
Have you employed here before: Yes No
If so, when:
Type of employed desired: Full-Time
Part-Time
Temporary
Seasonal
If part-time, specify days or hours desired:
Shift prefered:
Do you have a valid Driver's License: Yes No
If yes, #license:
Which state issued Driver's License:
Date you can start:
Have you been convicted of a crime in the last seven years: Yes No
If yes, please explain:
Are there any felony charges pending against you: Yes No
If yes, please explain:
Conviction or charges will not necessarily be a bar to
emploment. Each instance will be considered in relation to applied position.
State names of relatives working for us:
Employment History
Provide the following information for your past and current employers, assignments or volunteer activities, starting with the most recent.
Employer Name:
Phone:
Address:
Your Job Title:
Beginning Date of Employment:
Ending Date of Employment:
Beginning Rate of Pay:
Ending Rate of Pay:
Reason for Leaving:
May we contact for reference: Yes No Later
Employer Name:
Phone:
Address:
Your Job Title:
Beginning Date of Employment:
Ending Date of Employment:
Beginning Rate of Pay:
Ending Rate of Pay:
Reason for Leaving:
May we contact for reference: Yes No Later
Employer Name:
Phone:
Address:
Your Job Title:
Beginning Date of Employment:
Ending Date of Employment:
Beginning Rate of Pay:
Ending Rate of Pay:
Reason for Leaving:
May we contact for reference: Yes No Later
Educational Background
List any academic honors:
Military Service
Have you ever served in the Armed Forces: Yes No
If yes, in what branch:
Describe any training received revelant to the position for which you are applying:
References
Summary
Why would you like a position with Bohning Co., Ltd:
State any additional information that you feel may be helpful to us in considering your application. Include skills, experiences or abilities that qualify you to work at Bohning:
Authorization and Understanding
Upon the signing of this application, I represent that all of the information now or hereafter given by me in support of my application for employment is true and complete. I authorize you to verify any of the information concerning my employment, education or medical history with the appropriate individuals, companies, institutions or agencies and I authorize them to release such information as you require, including my prior disciplinary employment record, without any obligation to give me written notice of such disclosure. I also authorize you to release any information requested by any of my prospective or subsequent employers without any obligation to give me written notice of such disclosure. I hereby release you and them from any liability whatsoever as a result of any such inquiries and disclosures. If hired, I agree I will serve at the will of the firm and I agree that I shall be bound by the rules, policies, regulations and terms and conditions of employment of the firm as they are from time-to-time changed with or without notice to me. I agree that either party may terminate the employment relationship, with or without cause, at any time for any reason. I hereby authorize the firm to deduct from each and every period of pay any amounts necessary to offset any damages caused by me or the value of property or money entrusted to me by, or owed me to the firm during the course of my employment. I agree that these arrangements may only be altered in writing directed to me personally by the president of the firm. I further agree that if I should bring any action or claim arising out of my employment against the firm in which the firm prevails, I will pay to the firm any and all costs incurred by the firm in defense of said claims or actions, including attorney fees. Falsification or the omission of any material information requested will be grounds for refusal to hire, or for termination, if falsity or omission is discovered after the applicant is hired. As a condition of employment, employees agree not to commence any action or suit relating to their employment relationship with the company more than six (6) months after the date of termination of employment: further, employees agree to waive any Statute of Limitations to the contrary.
This application is current for only 90 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application or call the firm to update and keep current.
I understand that if I am hired, I will be required to provide proof of identity and legal work authorization.
I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA.
I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.
Fields marked with [*] are mandatory
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