FreemanWhite Employment Application:
Please fill in the information below.

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodations to the application and/or interview process should notify a representative of the Human Resources Dept.  
Information about the position you are applying for.
Position(s) applied for:
  
Date:
  
Referral Source:
 
Name of Source:
  
Date available for work:
  
Desired salary range?
  
Type of employment desired:
  

Your contact Information.
First Name:
  
Last Name:
  
Street Address:
  
 
City:
  
State:
  
Zip Code:
  
Home Telephone:
  
Mobile/Other Phone:
  
E-mail: 
 
Best time to call you at home:
 to  
May we Contact you at work?
  
If yes,
best time to call at work:
 to  
Work Number:
 

Employment Section.
Have you submitted an application here before?
If yes, give date(s) and position(s)
Have you ever been employed here before?
If yes, give date(s) and position(s)
Are you legally eligible for employment in the USA?
Will you relocate if job requires it?
Will you travel if job requires it?
Will you work overtime if job requires it?
If no please explain:
Have you ever pled guilty or no contest to, or been convicted of a crime?
If yes, please provide date(s) and details:
**Answering “yes” to these questions does not constitute an automatic bar to employment. Factors such as the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
Employment History Provide the following information of your past and current employers, assignments or volunteer activities, starting with the most recent. Explain any gaps in employment in the comments section below.
Most Recent Employment

Employer:
Telephone:
Dates Employed: (Month and Year)
 to
Street Address:
City:
State:
Zip:
Starting Job Title:
Final Job Title:
Immediate Supervisor and Title:
Reason for leaving:
May we contact for reference:
Starting Hourly Rate / Salary:
Final Hourly Rate / Salary:
Summarize the type of work performed and job responsibilities:
Previous Employer
Employer:
Telephone:
Dates Employed: (Month and Year)
 to
Street Address:
City:
State:
Zip:
Starting Job Title:
Final Job Title:
Immediate Supervisor and Title:
Reason for leaving:
May we contact for reference:
Starting Hourly Rate / Salary:
Final Hourly Rate / Salary:
Summarize the type of work performed and job responsibilities:
Previous Employer
Employer:
Telephone:
Dates Employed: (Month and Year)
 to
Street Address:
City:
State:
Zip:
Starting Job Title:
Final Job Title:
Immediate Supervisor and Title:
Reason for leaving:
May we contact for reference:
Starting Hourly Rate / Salary:
Final Hourly Rate / Salary:
Summarize the type of work performed and job responsibilities:
COMMENTS (including any gaps in employment)
Educational Background Summarize any special training, skills, licenses and/or certifications that may qualify you as being able to perform job-related functions in the position for which you are applying.
Educational Background Provide information for the last three schools attended.
School Name# years GPA/rankMajor  
References List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.
Name Relationship Telephone (include area code) # Years Known
Additional Information  
List professional, trade, business or civic associations and any offices held. Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve, national guard or any other similarly protected status.
List special accomplishments, publications, awards, etc. Exclude those that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve, national guard or any other similarly protected status.
Applicant Statement  

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still with to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I ACCEPT
Name Date

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