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Application for Employment -The Brant
Personal Information
Last Name
*
First Name
*
M.I.
Social Security Number
*
Date of Birth
(Optional)
Address
City
Zip Code
Phone Number
*
Email
*
Work Experience
List Most Recent Job First
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To
Employer's Name
Employer's Phone
Employer's Address
Position
Start Pay
End Pay
Reason for Leaving
Describe the Work You Did
From
To
Employer's Name
Employer's Phone
Employer's Address
Position
Start Pay
End Pay
Reason for Leaving
Describe the Work You Did
From
To
Employer's Name
Employer's Phone
Employer's Address
Position
Start Pay
End Pay
Reason for Leaving
Describe the Work You Did
General Information
What position are you applying for?
Position Type:
*
Full Time
Part Time
When are you available to start work?
Days/Times of week available to work
*
Please tell us the days and times during the week you're available to work
Are you at least 18 years old?
Yes
No
If not, can you provide a valid Work Permit, High School diploma, or Equivilent?
*
Yes
No
What languages do you speak, read, or write fluently?
If hired, can you verify that you have the legal right to work in the United States?
Yes
No
Do you have any special skills, training, or experience which may help you qualify for this job?
Yes
No
If so, please explain
*
Do you have a reliable means of transportation to get to work?
Yes
No
Do any of your relatives work for this company?
Yes
No
If so, who?
*
Have you ever worked for this company before?
Yes
No
If so, when?
*
Have you ever been convicted of a crime, excluding misdemeanors and summary offenses?
Yes
No
(Note: Conviction will not necessarily disqualify applicant)
If so, please explain
How did you find out about this job?
Certification and Acknowledgement
I certify that the information provided herein is true and correct to the best of my knowledge. I understand that, if employed, falsified statements on this Application for Employment form will be considered grounds for termination.
I authorize the company to thoroughly investigate my work experience and any other matters related to my suitability for employment. I further authorize my former employers to disclose to the company any and all information they may have concerning my previous employment. In addition, I hereby release the company, my former employers, and all other persons from any and all claims, demands, or liabilities arising out of, or in any way related to, such disclosure.
I acknowledge that, if employed, both The Brant and I have the right to terminate the employment relationship at any time, with or without cause or advance notice. This employment at will relationship will remain in effect throughout my employment with The Brant and may not be modified by any oral or implied agreement.
Signature
*
Use your cursor to draw your signature in the box above.
Date
*
Type Full Name
*
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Email
This field is for validation purposes and should be left unchanged.
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