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Employment Application Form






    Name: Position: Date:

    We consider applications for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, sexual, orientation, citizenship status, genetic information or any other legally protected status.

    Position(s) Applied For
    Date of Application
    How Did You Learn About Us?
    AdvertisementRelativeInquiryEmployment AgencyFriendOther
    [group other][/group]

    Last Name
    First Name
    Middle Name
    Address
    Number
    Street
    City
    State
    Zip Code
    Telephone Number(s)
    Social Security Number (Voluntary)
    Best time to contact you at home is:
    If you are under 18 years of age, can you provide required Proof of your eligibility to work?
    Have you ever filed an application with us before?
    [group if-application]Give date
    [/group]
    Have you ever been employed with us before?
    [group if-employed]Give date
    [/group]
    Do any of your friends or relatives, other than spouse, work here?
    Are you currently employed?
    May we contact your present employer?
    Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
    Proof of citizenship or immigration status will be required upon employment.
    Date available for work
    What is your desired salary range?
    Are you available to work: Full TimePart-TimeTemporary
    [group full-time]Please indicate 123shift[/group]
    [group part-time]Please indicate MorningsAfternoonEvenings[/group]
    [group temporary]Please indicate dates available [/group]
    Are you currently on “lay-off” status and subject to recall?
    Can you travel if a job requires it?

    WE ARE AN EQUAL OPPORTUNITY EMPLOYER

    EDUCATION

    Name and Address of School Course of Study Number of Years Complated Diploma Degree
    Elementary School
    High School
    Undergraduate College
    Graduate Professional
    Other (Specify)

    Describe any specialized training, apprenticeship, skills and extra-curricular activities.

    Describe any job-related training received in the United States military.

    EMPLOYMENT EXPERIENCE

    Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color religion, gender, national, origin, disabilities or other protected status.

    1

    Employer

    Address

    Telephone Number(s)

    Job Title

    Supervisor

    Reason for Leaving

    Dates Employeda
    Form
     
    To
    Hourly Rate/Salary
    Starring
     
    Final

    Work Performed

    2

    Employer

    Address

    Telephone Number(s)

    Job Title

    Supervisor

    Reason for Leaving

    Dates Employeda
    Form
     
    To
    Hourly Rate/Salary
    Starring
     
    Final

    Work Performed

    3

    Employer

    Address

    Telephone Number(s)

    Job Title

    Supervisor

    Reason for Leaving

    Dates Employeda
    Form
     
    To
    Hourly Rate/Salary
    Starring
     
    Final

    Work Performed

    4

    Employer

    Address

    Telephone Number(s)

    Job Title

    Supervisor

    Reason for Leaving

    Dates Employeda
    Form
     
    To
    Hourly Rate/Salary
    Starring
     
    Final

    Work Performed

    If you need aditional space, please continue on a separate sheet of paper

    List professional, trade, business or civic activities and office held.

    You may exclude membership which reveal gender, race, religion, national origin, age, ancestry, disability, or other, protected status:

    ADDITIONAL INFORMATION

    Other Qualifications

    Summarize special job-related skills and qualifications acquired from employment or other experience

    SPECIALIZED SKILLS (CHECK SKILLS/EQUIPMENT OPERATED)
    Production/Mobile Machinery (list) Other(list)
    _Terminal_Spreadsheet
    _PC/MAC_Word Processing
    _Typewriter_Shorthand
    WPM_WPM_

    State any additional information you feel may be helpful to us in considering your application.

    Note to Application: DO NOT ANSWAR THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

    Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation?

    REFERENCES

    1

    Name
    Phone
    Address

    2

    Name
    Phone
    Address

    3

    Name
    Phone
    Address

    APPLCANT’S STATEMENT

    I certify that answers given herein are true and complete.

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

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

    I hereby understand and acknowledge that, unless otherwise defined by applicable law, employment relationship with this organization is of an “at will” nature, which mean 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 changed by any written document or by conduct unless such change is specifically acknowledged 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.

    Signature of Applicant

    Date

    This Application For Employment is sold for general use throughout the United States. Amsterdam Printing and Litho assumes on responsibility for the use of said form or any questions which, when asked by the employer of the job applicant, may violate State and/or Federal Law.