Date of Application
MM
DD
YYYY
Name (Last, First, & Middle)
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Main Phone Number
*
(###)
###
####
Alternate Phone Number
(###)
###
####
Email
*
Name of Employer
Supervisor
Street Address
Main Phone Number
Dates Employed (Month/Year)
Pay Rate (Starting and Final)
Job Title and Duties
Reason for Leaving
May we contact?
Name of Employer
Supervisor
Street Address
Main Phone Number
Dates Employed (Month/Year)
Pay Rate (Starting and Final)
Job Title and Duties
Reason for Leaving
May we contact?
Name of Employer
Supervisor
Street Address
Main Phone Number
Dates Employed (Month/Year)
Pay Range (Starting and Final)
Job Title and Duties
Reason for Leaving
May we contact?
Have you ever been involuntarily terminated or asked to resign from any job?
If yes, please explain
Please explain any gaps in your employment history:
Please list any other experience, job related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualifications for employment.
High School Name
Years Completed
Diploma/Degree (Yes/No)
Course of Study/Major
Specialized Training, Skills, or Extracurricular Activities
College/University Name
Years Completed
Diploma/Degree (Yes/No)
Course of Study/Major
Specialized Training, Skills, or Extracurricular Activities
Graduate/Professional School Name
Years Completed
Diploma/Degree (Yes/No)
Course of Study/Major
Specialized Training, Skills, or Extracurricular Activities
School Name
Years Completed
Diploma/Degree (Yes/No)
Course of Study/Major
Specialized Training, Skills, or Extracurricular Activities
Name and Title
Relationship
Phone Number or Email
Name and Title
Relationship
Phone Number and Email
Name and Title
Relationship
Phone Number and Email
Name and Title
Relationship and Years Acquainted
Phone Number or Email
Name and Title
Relationship and Years Acquainted
Phone Number or Email
Name and Title
Relationship and Years Acquainted
Phone Number or Email
1) Have you ever used another name?
2) Is any additional information relative to name changes, use of an assumed name, or nickname necessary to enable a check on your work and educational record?
a. If yes to either of the above, please explain:
3) Have you ever worked for this company before?
a. If yes, please give dates and position:
4) Do you have friends and/or relatives working for this company? .
a. If yes, name(s) and relationship(s):
5) On what date are you available to begin work?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
7) Are you available to work?
Per Hour $
Per Month $
9) If hired, would you have a reliable means of transportation to and from work?
10) Can you travel if the position requires it? .
11) Can you relocate if the position requires it?
12) Are you at least 18 years old?
a. Note: If under 18, hire is subject to verification that you are of minimum legal age.
13) If hired, can you present evidence of your identity and legal right to work in this country?
14) Have you ever been convicted of a felony in the last seven years?
(Conviction will not necessarily disqualify an applicant from employment.)
If yes, please explain:
.I hereby authorize the Company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
In the event of my employment with the Company, I understand that I am required to comply with all rules and regulations of the Company.
If hired, I understand and agree that my employment with the Company is at-will, and that neither I, nor the Company is required to continue the employment relationship for any specific term. I further understand that the Company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.
I understand that safety of employees is extremely important to the Company and that the Company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.
I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an lg Form in this regard.
I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable.
I understand for positions pertaining to driving vans and trucks. Applicant must be 21 years of age.
I authorize Cleveland Vicon to check my riving records with the Ohio Bureau of Motor Vehicles.
