Employment Application

APPLICATION FOR PART TIME EMPLOYMENT OR CONTRACTUAL ARRANGEMENT

Personal Information


Background Information

Are you a United States citizen? (If NO, enter citizenship here.)

If No, are you legally authorized to work in the U.S.?

Have you ever been convicted of a felony or a first degree misdemeanor? (If YES, explain on the reverse side)

A complete background check may be performed upon accepting a position or contractual agreement with us. Do you consent to a background check should your application for employment be accepted?


Employment History


Education


Restrictions

Any restrictions? (If any, please indicate on reverse side of this application).

Are there any days or shifts you are unable to work?

Do you have transportation available to you?

Are you able to work weekends and evenings?

Do you require any special assistance or equipment?

Any restrictions on use of a computer, mouse, keyboard or the internet?

Rate YOUR Spelling and Grammatical skills (0 -­5) with 0 = Low through 5 = High

Rate YOUR Computer skills (0 -­‐ 5) with 0 = Low Through 5 = High


Drivers License

Statement -­‐ I hereby certify that the facts set forth in this application are true and complete.
False Statements may be cause for employee termination. References will be checked.