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Application for Employment

We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization.

Applicant Name

First Last

Positions Applied For

Your Address

Street Address Address Line 2 City State ZIP Code

Phone

Social Security #:

Type of Employment Desired:

full-time

part-time

seasonal

Date You Will Be Available To Start Work

Email Address:

Are you able to meet the attendance requirements (including Saturdays)?

Yes

Do you have any objection to working overtime if necessary?

Yes

Can you travel if required by this position?

Yes

Have you ever been previously employed by our organization?

Yes

Can you submit proof of legal employment identification & authorization to work in U.S.A.?

Yes

If you are under 18, can you furnish a work permit if it is required?

Yes

How were you referred to us?

Employment History

Provide all employment information for your past four employers starting with the most recent.

Employer:

Position Held:

Employer Address:

Employer Phone:

Job Title:

Immediate Supervisor and Title:

Dates Employed:

From:

To:

Salary:

Reason For Leaving:

Employer:

Position Held:

Employer Address:

Employer Phone:

Job Title:

Immediate Supervisor and Title:

Dates Employed:

From:

To:

Salary:

Reason For Leaving:

Employer:

Position Held:

Employer Address:

Employer Phone:

Job Title:

Immediate Supervisor and Title:

Dates Employed:

From:

To:

Salary:

Reason For Leaving:

Employer:

Position Held:

Employer Address:

Employer Phone:

Job Title:

Immediate Supervisor and Title:

Job Title:

Dates Employed:

From:

To:

Salary:

Reason For Leaving:

Other Skills and Qualifications

Summarize any job-related training, skills, licenses, certificates, and/or other qualifications:

Educational History

List school name and location, years completed, course of study, and any degrees earned:

High School:

College:

Technical Training:

Any Other Training:

References

List 3 references who have knowledge of your job skills (e.g. supervisors/managers, co-workers) including names, telephone numbers, and years known:

First Reference

First Name Last Name

Phone

Years Known:

Second Reference

First Name Last Name

Phone

Years Known:

Third Reference

First Name Last Name

Phone

Years Known:

Consent(Required)

I agree

I hereby certify that all information in the application is true and complete and I agree and understand that any falsification of information contained herein, regardless of time of discovery, may be cause for termination of employment or consideration for employment. I understand that all information on this application is subject to verification and I authorize King + Cross Companies to contact and verify the accuracy of information regarding my work performance, whether such information is favorable or unfavorable to me, from all previous employers, educational institutions, and references. I also hereby fully release from liability the company and its representatives for gathering and using such information to make employment decisions and all other persons or organizations for providing such information.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either the employer or I can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA. If you would like to request a reasonable accommodation during the interview process, please inform the HR Manager prior to your interview. King + Cross Companies is an Equal Opportunity Employer who embraces diversity. We do not discriminate in the hiring process based on federally protected classifications such as: race, color, national origin, ancestry, religion, disabilities, sex, sexual orientation, veteran status, age or marital status.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.

I acknowledge that I have read and fully understand the information herein and that I seek employment under these conditions.

Date