Employment Application

Personal Information
Name:
Home Address:
City:
State:
Zip:
Phone: ()
Email:
Are you at least 18 years old? Yes No
Are you legally eligible for employment in the United States? Yes No
Availability
  MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY
FROM
TO
Available Start Date:
Wage desired: $
Number of hours desired per week:
Education
  School Name Major Course of Study Last Year Completed Did you graduate?
High School 1 2 3 4 Yes No
College 1 2 3 4 Yes No
Other 1 2 3 4 Yes No
Have you served in the US Armed Forces? If so, what branch?
List any additional training or skills that may be relevant to the position that you are applying for:
Other Information
Have you ever been employed by One Stop, Inc.? Yes No
If yes, previous dates of employment:
Can you, with or without a reasonable accommodation, perform the essential functions of the job for which you applied? Yes No
Please explain:
Have you ever been convicted of a felony or have felony charges pending? Yes No
If yes, please explain:
How many pounds can you lift on a continuous basis?
Would you be willing to take a drug test? Yes No
Employment History
Current or more recent employer
Name:
Address:
Phone: ()
Start Date:
End Date:
Start Wage:
End Wage:
Hours Worked Per Week:
Job Title:
Job Duties:
Reason for Leaving:
Next most recent employer
Name:
Address:
Phone: ()
Start Date:
End Date:
Start Wage:
End Wage:
Hours Worked Per Week:
Job Title:
Job Duties:
Reason for Leaving:
Next most recent employer
Name:
Address:
Phone: ()
Start Date:
End Date:
Start Wage:
End Wage:
Hours Worked Per Week:
Job Title:
Job Duties:
Reason for Leaving:
References
Reference 1
Name:
Company:
Phone: ()
Position:
Reference 2
Name:
Company:
Phone: ()
Position:
Reference 3
Name:
Company:
Phone: ()
Position: