Employment Form

All applicants for employment are required to complete and submit this Employment Application. The Company does not discriminate on the basis of sex, age, color, race, religion, marital status, national origin, ancestry, sexual orientation, physical & mental disability, medical condition, genetic information, veteran status or any other basis protected by federal, state or local law.

APPLICANT INFORMATION

Last Name *

First *

M.I. *

Date *

Street Address

Apartment/Unit #

City *

State *

Zip *

Phone *

Email *

Date Available *

Desired Salary *

Position Applied forSelect optionSelect optionSenior AccountantAudit ManagerBookkeeperPayroll Specialist

How did you hear about this position?Select optionSelect optionJob boardReferralSocial mediaCompany website

Are you authorized to work in the U.S.? *

• Yes
• No

Have you ever worked for this company? *

• Yes
• No

If so, when?

Can you travel if the position requires it? *

• Yes
• No

EDUCATION

High School *

Address

From *

To *

Did you graduate? *

• Yes
• No

Degree *

College *

Address

From *

To *

Did you graduate? *

• Yes
• No

Degree *

Other

Address

From

To

Did you graduate?

• Yes
• No

Degree

ANY PROFESSIONAL DESIGNATIONS, TRAINING, PATENTS, PUBLICATIONS, COMPUTER SKILLS RELATED TO THE JOB SOUGHT:

REFERENCES

Please list three professional references.

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

PREVIOUS EMPLOYMENT

Company *

Phone *

Address *

Supervisor

Job Title *

Responsibilities *

From *

To *

Reason for Leaving *

May we contact your previous supervisor for a reference? *

• Yes
• No

Company

Phone

Address

Supervisor

Job Title

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

• Yes
• No

Company

Phone

Address

Supervisor

Job Title

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

• Yes
• No

MILITARY SERVICE

Branch

From

To

Rank at Discharge

Type of Discharge

If other than honorable, explain

INDICATE LANGUAGES YOU SPEAK, READ AND/OR WRITE

Enter Language

Speak

Multiple Choice

• Fluently
• Well
• Passably

Read

Lang Level

• Fluently
• Well
• Passably

Write

Lang Level

• Fluently
• Well
• Passably

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature *

Date *

hidden label and field

Please read the below carefully and then initial next to each paragraph.
Please sign and date in the space provided at the bottom of this page.

CERTIFICATION AND RELEASE *

• I authorize the Company to verify, in any manner, all statements made by me. The Company may, for example, interview former employers, co-workers, schools, references or others and request information and supporting documentation such as transcripts and evaluations.
• I authorize any and all former employers, references or educational institutions to release all information relevant to my employment or education to the Company, without giving me prior notice.
• I release from any liability or responsibility all persons, companies and corporations supplying any informa- tion in verifying my statements above, as well as the Company in connection with its obtaining such information for use in verifying my statements above.
• I shall preserve in strictest confidence all information regarding the business or customers of the Company that may be disclosed to me or come to my attention in the process of applying for a position with the Company.
• If employed by the Company, I agree to comply with the Company’s policies and procedures, safety rules and cooperate in any reasonable security investigation. I understand that I am not employed by or entitled to employment by the Company unless and until I have received and accepted a written offer of employment from a Company representative. I also understand that no other act of the Company, including the acceptance of my application for employment, the scheduling of interviews with me or any oral or written statements of interest or encouragement, creates an employment relationship with me, and I will not rely on any such act of the Company. I understand that if I am employed by the Company, such employment is “at-will,” which means that my employment and related compensation may be terminated at any time, with or without cause, and with or without advance notice by me or by the Company.
• I understand that any misrepresentation or omission of fact on this application, my resume, any supple-mentary materials submitted by me and interview responses, may be cause for a refusal to hire me or the termination of employment at any time during the period of my employment.
• I understand that this Application is not a contract of employment.

APPLICANT SIGNATURE: *

DATE: *

APPLICANT’S NAME: *

(Please Print)

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