Apply For Employment | Hagen Glass

Personal Data

Employer:

Position(s) applying for:

Name

First Middle Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home phone

Business phone

Cell phone

Date you can start work

Month

Day

Year

Desired salary

Do you have a high school diploma or GED?

Yes

Position Information

Check all that you are willing to work.

Hours

Full time

Part time

Time of day

Days

Evenings

Type of shift

Swing

Graveyard

Weekends

Status

Regular

Temporary

Are you authorized to work in the U.S. on an unrestricted basis?

Yes

Have you been told the essential functions of the job or have you viewed a copy of the job description listing the essential functions of the job?

Yes

Can you perform these essential functions of the job with or without reasonable accomodation?

Yes

Have you ever been convicted of a felony?

Convictions will not necessarily disqualify an applicant for employment

Yes

If yes, please explain:

Qualifications

Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training.

School name

Degree:

Address

City/state

School name

Degree:

Address

City/state

Other

Degree:

Address

City/state

Special skills

Please list any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc)

References

Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don't have three professional references, then list personal, unrelated references.

Name

Address

City/State

Phone

Relationship

Name

Address

City/State

Phone

Relationship

Name

Address

City/State

Phone

Relationship

Work History

Start with your present or most recent employment and work back. Use separate sheet if necessary. (Include paid and unpaid positions).

Job #1

Job title

Start date

End date (if applicable)

Company name

Supervisor's name

Phone number

City

State

Zip code

Duties

Reason for leaving

Starting salary

Ending salary

May we contact your current employer?

Yes

N/A

Job #2

Job title

Start date

End date

Company name

Supervisor's name

Phone number

City

State

Zip code

Duties

Reason for leaving

Starting salary

Ending salary

Job #3

Job title

Start date

End date

Company name

Supervisor's name

Phone number

City

State

Zip code

Duties

Reason for leaving

Ending salary

Starting salary

Job #4

Job title

Start date

End date

Company name

Supervisor's name

Phone number

City

State

Zip code

Duties

Reason for leaving

Starting salary

Ending salary

Sign and date

Certification

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application. I acknowledge and understand that the company is an "at will" employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.

I certify the information provided is true to the best of my knowledge.

Applicant signature

Typed name will act as signature.

Date

Month

Day

Year

Apply Now

Fill out an employment application:

Personal Data

Position Information

Qualifications

References

Work History

Job #1

Job #2

Job #3

Job #4

Sign and date

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