Employment Application

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Employment Application

Applicants may be tested for illegal drugs.

* Required

First Name *

Middle Name

Last Name *

Present Address

Street Address *

City *

State

Zip Code *

How long have you been living at this address?

Contact Information

Home Phone *

Cell Phone *

Email *

Work Information

Position applied for. *

Desired salary.

Date of Birth *

Type of Employment Desired

Full-Time Only Part-Time Only Full-Time or Part-Time

Days / Hours Available for Work *

No Preference

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

How many hours can you work weekly?

Are you available to work nights?

If hired, when would you be able to begin working? *

List any office or computer skills you may possess.

Education

School	Name	Location	Number of Years Completed	Major or Degree Achieved
High School
College
Business or Trade School
Professional School

Criminal History

Have you ever been convicted of a crime? Yes No

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.
Note: The existence of a conviction will not necessarily preclude you from employment; the nature of the crime and its relationship to the position applied for, the degree of rehabilitation of the applicant and the time elapsed since the crime or release from confinement will all be considered.

Driving Information

Do you have a driver's license? * Yes No

What is your primary means of transportation to work?

Select any of the following driver's license classifications that you may possess.
Operator Commercial (CDL) Chauffeur

If potentially driving a company vehicle, NAFECO will need to obtain a copy of your motor vehicle driving record. Do you agree to this? *
Yes No

Have you had any accidents during the past five years? *
Yes No
How many?

Have you had any moving violations during the past five years? *
Yes No
How many?

References

Please list two references other than relatives or previous employers.

1) Name Position Company Address Phone

2) Name Position Company Address Phone

Personal Qualifications

Please use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

Military Background

Have you ever served in the armed forces? Yes No

Are you now a member of the National Guard? Yes No

Specialty

Date Entered

Discharged Date

Work Experience

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name.

Employer Name *

Address *

Alt. Address

City *

State *

Zip Code

Telephone

Supervisor Name

Employment Dates:
This is my current job.
Employed From Employed To

Pay / Salary:
Starting Pay Final Pay

Final Job Title *

Reason for leaving. Please be specific.

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Employer Name

Address

Alt. Address

City

State

Zip Code

Telephone

Supervisor Name

Employment Dates:
Employed From Employed To

Pay / Salary:
Starting Pay Final Pay

Final Job Title

Reason for leaving. Please be specific.

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Employer Name

Address

Alt. Address

City

State

Zip Code

Telephone

Supervisor Name

Employment Dates:
Employed From Employed To

Pay / Salary:
Starting Pay Final Pay

Final Job Title

Reason for leaving. Please be specific.

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Employer Name

Address

Alt. Address

City

State

Zip Code

Telephone

Supervisor Name

Employment Dates:
Employed From Employed To

Pay / Salary:
Starting Pay Final Pay

Final Job Title

Reason for leaving. Please be specific.

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact your present employer? Yes No

Are you completing this application for another individual? Yes No

If yes, please enter your name.

Applicant's Statement

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applicants are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

I agree with the above statement.

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Employment Application

Applicants may be tested for illegal drugs.

* Required

Present Address

Contact Information

Work Information

Type of Employment Desired

Days / Hours Available for Work *

Education

Criminal History

Driving Information

References

Please list two references other than relatives or previous employers.

Personal Qualifications

Military Background

Work Experience

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name.

Applicant's Statement

Information

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