Employment application for CAC

EMPLOYMENT APPLICATION We are an Equal Opportunity Employer. It is our policy to abide by all Federal, State, and local laws concerning discrimination in employment. No question in this application is intended to elicit information in violation of any such law nor will any information obtained in response to any question be used in violation of any such law.
Personal Information
Last Name		First Name	Middle
Address		City
State/Prov	Zip	Country
Phone:		E-mail:
Social Security #


How long at present address?
Were you previously employed by this organization?		If Yes, date(s)?
Have you previously applied to this organization?		If Yes, date(s)?
Are you over age 18?
Position applying for		Wages expected

Please specify which you would consider:
Full Time?	Part Time? Temporary?
Willing to work overtime? (If no, please explain)
Are you employed now?
If so, date available?
Education and Training
High School Name & Location
Course of Study
# of Years Completed	Did you graduate? Diploma or Degree
*******************
College /Univ Name & Location
Course of Study
# of Years Completed	Did you graduate? Diploma or Degree
*******************
College /Univ Name & Location
Course of Study
# of Years Completed	Did you graduate? Diploma or Degree
*******************
Trade School Name & Location
Course of Study
# of Years Completed	Did you graduate? Diploma or Degree
*******************
Apprentice School Name & Location
Course of Study
# of Years Completed	Did you graduate? Diploma or Degree
List any other education, training, special skills or certifications / licenses that you posses:

List any machines or equipment that you are qualified and expericed at operating:

Experience List the last 10 years work experience beginning with most recent
Company Name
Address
Name / Title of Supervisor
May we contact?	Employed full time / part time?
Phone
Type of Business
Employed From	Employed To
Wages Starting	Wages Last
State last job title and describe your work

Reason for leaving

*******************
Company Name
Address
Name / Title of Supervisor
May we contact?	Employed full time / part time?
Phone
Type of Business
Employed From	Employed To
Wages Starting	Wages Last
State last job title and describe your work

Reason for leaving

*******************
Company Name
Address
Name / Title of Supervisor
May we contact?	Employed full time / part time?
Phone
Type of Business
Employed From	Employed To
Wages Starting	Wages Last
State last job title and describe your work

Reason for leaving

*******************
Have you had any other experiences or qualifications in addition to those indicated above which relate to the job for which you are applying? If so, please describe:

References List business persons known, but not related to you, other than listed above
Reference Name
Title
Business
Phone
Years known
*******************
Reference Name
Title
Business
Phone
Years known
*******************
Reference Name
Title
Business
Phone
Years known

Additional Employment - Related Information List any relatives or friends working for this organization
Name
Relationship
*******************
Name
Relationship
Can you verify your legal right to work in the US by providing a birth certificate, proof of US citizenship, or by some other means?
Do you have any physical or mental condition or disability which precludes or limits your ability to perform the job(s) for which you are applying?
If "yes", please explain
Have you been convicted of a crime in the past 10 years, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court?
If "yes", please explain

Previous Addresses List previous addresses during the past 5 years
Address
City, State, Zip
From
To
*******************
Address
City, State, Zip
From
To
*******************
Address
City, State, Zip
From
To
Additional Remarks:

Applicant's Certification (please read carefully before signing) I certify that, to the best of my knowledge and belief, the answers given by me to the foregoing questioning and the statements made by me in this application are correct and complete. I understand that misrepresenation or omission of facts in this application may result in my discharge. I authorize you to communicate with those employers I designated, school officials and persons named as references concerning my skills, character, and responsibility. If employed, I understand and agree that such employment may be terminated at any time, with or without prior notice and that my employment will not be governed by any expressed or implied contract but is at-will.
	Sign
Please note that your submission of this documents constitutes your agreement to use electronic signatures in lieu of a paper document with a traditional hand-written signature. Electronic signatures are legally recognized throughout the United States.

EMPLOYMENT