Employment Application Employment Application Step 1 of 3 33% Please fill out the 3 page online application. It is not officially submitted until you hit the submit button on the 3rd page. * denotes a required field Applicant Information:First Name* Middle Last Name* Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Datetime Phone*Evening Phone*Email Date Available MM slash DD slash YYYY Desired Pay $ Job Position Applying for* Are you a citizen of the United States?* Yes No If no, are you authorized to work in the United States? Yes No Have you ever worked for this company? Yes No If yes, when? Yes No Have you ever been convicted of a felony?* Yes No If your answer to the above is “Yes”, please provide details, including dates below:Applicant Employment HistoryEmployer #1Company Name* Phone*Address Street Address City State / Province / Region ZIP / Postal Code Job Title* Supervisor Name Job Duties* Starting Salary $ Ending Salary $ Dates of EmploymentFrom ( Month / Year):* To ( Month / Year):* Reason for Leaving* Need Employer #2 Section?* Yes No Employer #2Company* Phone*Address Street Address City State / Province / Region ZIP / Postal Code Job Title* Supervisor Name Job Duties* Starting Salary $ Ending Salary $ Dates of EmploymentFrom date ( Month / Year)* To date ( Month / Year)* Reason for Leaving* Need Employer #3 Section?* Yes No Employer #3Company* Phone*Address Street Address City State / Province / Region ZIP / Postal Code Job Title* Supervisor Name Job Duties* Starting Salary $ Ending Salary $ Dates of EmploymentFrom date (Month / Year)* To date (Month / Year)* Reason for Leaving* Applicant Education and TrainingHigh School Address Did you graduate? Yes No College/University Name Address DId you receive a degree? Yes No If yes, degree(s) received Other Training (Graduate, Technical, Vocational) include dates Professional ReferencesPlease provide three professional references --- Professional Reference #1 ---Full Name* Relationship Company Phone*Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code --- Professional Reference #2 ---Full Name* Relationship Company Phone*Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code --- Professional Reference #3 ---Full Name* Relationship Company Phone*Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Military ServiceBranch From* MM slash DD slash YYYY To* MM slash DD slash YYYY Rank at Discharge Type of Discharge If other than honorable, explain:Application StatementI understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer's service, whenever it is discovered. I give the employer the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I understand that I must undergo a fingerprint background check consistent with federal, state, and local laws, school district and TEA requirements, and any other funder requirements prior to any formal offer can be made. I hereby release from liability the employer and its representatives for seeking, gathering and using such information. 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 local, state, or federal law. This application is current for only 90 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application.* I certify Date MM slash DD slash YYYY