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General Information

First Name *

Middle Name *

Last Name *

Email Address *

Telephone No./ Phone No. *

Present Street Address *

City *

State *

Zip Code *

Are you 18 years of age or older? *

(If you are hired, you may be required to submit proof of age.)

Job Related Information

Are you seeking: *

Full-time

Temporary

Part-time

When could you start work? *

Have you ever applied here before? *

Were you ever employed here? *

If employed, do you expect to be engaged in any additional business
or employment outside of our job? *

For Driving Jobs Only: Do you have a valid driver’s license?

Work History
List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including
military service and any periods of unemployment. If self-employed, give firm name and supply business references. Note: A job
offer may be contingent upon acceptable references from current and former employers.

Experience Details

JOB TITLE

ACTION

Education
LIST NAME AND ADDRESS OF SCHOOLS

SCHOOL NAME

ACTION

What skills or additional training do you have that relate to the job for which you are applying?

What machines or equipment can you operate that relate to the job for which you are applying?

Reference

Have you worked or attended school under any other names?

Are you presently employed?

Have you ever been fired from a job or asked to resign?

Give three references, not relatives or former employers.

Submit
PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENT OF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE.

E-Signature *

Date *

I have read, understand, and by my signature consent to these statements.

Explore Exciting Volunteer Opportunities with LIFT-UP

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