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PLEASE COMPLETE FORM.
DATE
Name
Present address
How long
Social Security No.
Birth Date.
Telephone
If under 18, please list age
Position applied for (1)
and salary desired (2)
(Be specific)
Days/hours available to work
No Pref
Thur
Mon
Fri
Tue
Sat
Wed
Sun
How many hours can you work weekly?
Employment desired
FULL-TIME ONLYPART-TIME ONLYFULL- OR PART-TIME
When available for work?
TYPE OF SCHOOL
NAME OF SCHOOL
LOCATION (Complete mailing address)
NUMBER OF YEARS COMPLETED
MAJOR & DEGREE
High School
College
Bus. or Trade School
Professional School
HAVE YOU EVER BEEN CONVICTED OF A CRIME?
NoYes
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.
DO YOU HAVE A DRIVER’S LICENSE?
YesNo
What is your means of transportation to work?
Driver’s license number
State of issue
OperatorCommercial (CDL)Chauffeur
Expiration date
Have you had any accidents during the past three years?
How many?
Have you had any moving violations during the past three years?
An application form sometimes makes it difficult for an individual to adequately summarize a complete background. 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
HAVE YOU EVER BEEN IN THE ARMED FORCES?
ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?
Specialty
Date Entered
Discharge 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. Attach additional sheets if necessary.
Name of employer
Address
City, State, Zip Code
Phone number
Name of last supervisor
Employment dates
Pay or salary
Your last job title
Reason for leaving (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?
Did you complete this application yourself
If not, who did?
In exchange for the consideration of my job application by
Smith Challenger Mfg. & Services,Inc. (hereinafter called “the Company”), I agree that:
Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Smith Challenger Mfg. & Services,Inc. or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. Both the undersigned and Smith Challenger Mfg. & Services,Inc. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.
I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.
I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.
I further understand that my employment with the Company shall be probationary for a period of ninety (90) calendar days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.
Signature of applicant
Date:
This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.
Thank you for completing this application form and for your interest in our business.
