EMPLOYMENT APPLICATIONHaga click aqui para llenar un formato de empleo en español First Name * Middle Initial Last Name * Today's Date * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Cell Phone (###) ### #### Alternate Phone (###) ### #### Email PLEASE PLACE A CHECK BY YOUR RESPONSE OR PROVIDE THE APPROPRIATE INFORMATION. Are you interested in: Temporary Permanent Placement Part Time How did you hear about us? Classified Ad Friend Radio Internet Other Minimum Hourly Pay Minimum Annual Pay Annual Pay Desired Have you ever been convicted of a felony, convicted of a misdemeanor involving dishonesty or moral turpitude, or convicted in a military court martial? (A conviction will not automatically bar you from employment) * Yes No If yes, please explain: Is it legal for you to work in this country? * Yes No Desired Start Date * MM DD YYYY What hours do you prefer to work? * Check all that apply Full-time Part-time Full-Time 2nd Shift Full-Time 3rd Shift Weekend Days Will you work in a non-smoking environment? * Yes No Can you work at locations not accessible by public transportation? * Yes No COMPLETE THIS SECTION IF YOU ARE LOOKING FOR A PERMANENT POSITION. Position Desired Would you consider a position involving relocation, even at your own expense? Yes No If yes, please check all location preferences that apply. Brookfield, WI Cedarburg, WI Hartland, WI Milwaukee, WI Muskego, WI Waukesha, WI PLEASE LIST YOUR WORK EXPERIENCE BELOW. (LAST JOB FIRST) Company Name City Phone Number (###) ### #### Supervisor's Name What does the company do? Position or Duties Reason for leaving Salary/Pay Rate Bonus Start Date: MM DD YYYY End Date: MM DD YYYY Company Name City Phone Number (###) ### #### Supervisor's Name What does the company do? Position or Duties Reason for leaving Salary/Pay Rate Bonus Start Date: MM DD YYYY End Date: MM DD YYYY Company Name City Phone Number (###) ### #### Supervisor's Name What does the company do? Position or Duties Reason for leaving Salary/Pay Rate Bonus Start Date: MM DD YYYY End Date: MM DD YYYY RELEVANT EDUCATION (LIST MOST RECENT FIRST) College/School City Degree Major GPA Graduate? Yes No Other Education Information College/School City Degree Major GPA Graduate? Yes No Other Educational Information PROFESSIONAL CERTIFICATIONS, AFFILIATIONS AND/OR LICENSES (INDICATE STATE) REFERENCES Reference #1 First Name Last Name Relationship Company Phone (###) ### #### Reference #2 First Name Last Name Relationship Company Phone (###) ### #### Reference #3 First Name Last Name Relationship Company Phone (###) ### #### General: I submit this form to the company for the purpose of obtaining permanent, temporary, or contract employment. I understand that I will never be charged a fee by the company. I acknowledge that the use of this form, and my filling it out, does not indicate that any positions are open, nor does it obligate the company to further process my application. I certify as to the accuracy of the matters set forth herein and in my resume and understand that any misstatement of fact may cause me to be refused employment or to lose my employment. * Yes No References: I hereby authorize the company and its agents to make such investigations and inquires into my employment and educational history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, and other persons from all liability in responding to inquires connected with my application and I specifically authorize the release of information by any schools, businesses, individuals, services or other entities listed by me in this form. Furthermore, I authorize the company and its agents to release any reference information to clients who request such information for purposes of evaluating my credentials and qualifications. * Yes No Do you have any friends who might like to apply with us? If so, please provide names and phone numbers. Name First Name Last Name Phone (###) ### #### Name First Name Last Name Phone (###) ### #### Thank you!
