Employment Application

INSTRUCTIONS: At least one previous employment history and one reference are required. Please be as complete and accurate as possible and click the agreement button at the bottom. At that time your information will be emailed to our human resources department. Thank you.
Name - Last, First, Middle Initial
 Today's Date  (mm/dd/yyyy)
Present Address
Street
 City
 State
 Zip
Permanent Address
Street
 City
 State
 Zip
Area Code & Home Phone
 Area Code & Work Phone
 Email Address

What type of work do you prefer?

Full Time Part Time

If other please explain

 
Have you ever been convicted of a felony? (Record of conviction does not disqualify applicant from employment consideration.)
Yes
No		 If yes, please explain:
May we contact your present employer?
Yes No
Salary required
 Date available
 
Who referred you to 24Hour Comfort?
Advertisement Employee Internet Outreach (Government Agency)
Client Referral Former Employee Job Fair Unsolicited

Education

School Name & Location Years Attended Graduate? Major Subject or
Total Hours, if applicable
From To
High School
   Yes
No
College/University
 Yes
No
College/University
 Yes
No
Highest Degree Earned:
High School Bachelor Doctorate
Associate Master

Overall College
Scholastic Average:
Describe any certifications you have:
 Do you have plans for continuing your education?
If yes, please explain.

Do you have your own tools?
Yes No		   Will you work overtime?
Yes No

Employment History:
List all employment (include U.S. Military Service). Start with present or most recent positions. Include all jobs since age 18 (or last four jobs, whichever is less)

Dates Name and Address
of Employer		 Position & Responsibilities Reason for
Leaving
From:

To:
Supervisor:

May we contact?
Yes No
Start Salary:
End Salary:
From:

To:
Supervisor:

May we contact?
Yes No
Start Salary:
End Salary:
From:

To:
Supervisor:

May we contact?
Yes No
Start Salary:
End Salary:

Outside Activities

Professional memberships, certificates or licenses held. (Exclude those indicating race, color, religion, sex, national origin, age, handicap or Vietnam-era veteran status):

Professional/Work References We May Contact (Include Area Codes with Phone Numbers):

Name:
Relationship (mgr, supv, customer, etc.): 		Relationship At Which Organization 
 Phone No. 
Name:
Relationship (mgr, supv, customer, etc.): 		Relationship At Which Organization
 Phone No.
Name:
Relationship (mgr, supv, customer, etc.): 		Relationship At Which Organization
 Phone No.
Name:
Relationship (mgr, supv, customer, etc.): 		Relationship At Which Organization
 Phone No.

I certify that the answers provided herein are accurate to the best of my knowledge and belief. I am aware that failure to complete this application, intentional omissions or misstatements may result in refusal of employment or discharge. I understand that my criminal background, past employment and education will be investigated, and I hereby grant permission for that to be done, as well as the verification of any other information herein.

I will also, if hired, comply with all work and safety rules and regulations. I understand that failure to comply with these rules could result in my termination. I also understand that my employment (is at will) and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either 24 hour Comfort.or myself.  

 

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