MRS Employment Application [raw] Personal Information Name Last Name First Name Middle Name Date and Phone Date Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Phone # Alternate Phone # Address City State Zip Code Are You Over 18? Yes No Emergency Contact Person / Relation Contact Phone # Email address Social Security # Drivers License # State Are you a citizen of the U.S. or do you have the legal right to be employed in the U.S.? Yes No Have you been convicted of any crime (excluding minor traffic violations) including DWI? Yes No If you answered yes, please state the offense, location, date and disposition: Employment Desired What kind of employment are you seeking? Part Time Full Time Temporary / Summer Position applying for: Desired Salary? Date Available: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Have you ever: applied or worked for our company before? If yes, when did you apply or work for our company and what position did you apply for or hold? How did you hear about our company and/or position? Are you now or do you expect to be engaged in any other business or employment? Yes No Are there any days or hours you would be unwilling to work? Yes No If yes, please specify those days or hours: There may be times both planned and unexpected that your position may require travel. If employed, are you willing and able to comply with this policy? Yes No If employed, do you agree to comply with this company's safety policies and procedures? Yes No Education / Military High School: Year(s): Graduate? Yes No College: Year(s): Graduate? Yes No Other Training: Year(s): Graduate? Yes No Please list any job related / computer skills that you have: Please list any languages you speak fluently: Have you ever served in the military? Yes No Branch: Dates: Separation: Final Ranking: Honors: Are you currently a member of a reserve organization? Yes No If yes, which: Employment History Please answer all questions completely and accurately. All information is subject to verification. Employer: Supervisor: Address: Phone #: Position: Duties: Beginning Month/Year: Ending Month/Year: Beginning Salary/Wage: Ending Salary/Wage: Reason for leaving: May we contact this employer: Yes No Employer: Supervisor: Address: Phone #: Position: Duties: Beginning Month/Year: Ending Month\Year Beginning Salary/Wage: Ending Salary/Wage: Reason for leaving: May we contact the employer: Yes No Employer: Supervisor: Address: Phone #: Position: Duties: Beginning Month/Year: Ending Month/Year: Beginning Salary/Wage: Ending Salary/Wage: Reason for leaving: May we contact the employer: Yes No Personal References Name: Relation: Phone #: Occupation: Year's known: Name: Relation: Phone #: Occupation: Years known: Name: Relation: Phone #: Occupation: Years known: Our company is an equal opportunity employer and adheres to the principles and practices outlined in Title VII of the Civil Rights Act of 1964, which prohibits discrimination of employment on the basis of race, sex, religion, or national origin. Public Law 90-202 which prohibits discrimination based on age, and Public Law 101-336 which prohibits discrimination based on disabilities. This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Affidavit: I verify that the answers given by me to the foregoing questions and statements are true and correct without any intentional omissions of any kind whatsoever. I understand that any misleading or incorrect statements may render this application void and, if employed, would be cause for my termination. I further agree that the company shall not be liable with respect if my employment is terminated because of false statements, answers or omissions made by me in this questionnaire. I also authorize the companies, schools or persons named above to give any information regarding my employment, character, and qualifications and hereby release said companies, schools or persons from all liability for any usage for issuing this information. I further understand that drug testing is a condition of employment and refusal to take such tests when asked will subject me to termination. I understand that failure to comply with company policies and plans will lead to termination. I also understand that no person is authorized to enter into any written or oral employment contracts on my behalf of the company without the express written consent of the President. Signature: Date Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Type the characters (required) This field should be left blank Send Please wait... [/raw]
