Application Form

Today’s Date:_____________

 

 

General Instructions:

1.  PRINT or write all information so that it is legible .

2.  If an item does not apply to you, or you have no information to furnish, print in the letters "N/A" meaning Not Applicable.

3.  A completed application is required.  Resumes may be submitted in addition to the application. 

4.  This application requires the applicant's signature and date of signature (refer to the last page of this application).

 

Position for which you are applying                                         Date:

 

Last Name

First

Middle

 

Address

Marital Status:

# of dependents:

 

City

State

Zip

 

Home Phone(         )                                                      

Message Phone(         )                                             

 

Date Available for work

Minimum Salary Requirement

 

Social Security Number                                     DOB:

 

YES

NO

 

 

YES

NO

 

 

 

1.          Do you work well with others?

 

 

 

7.          Do you consent to the following:  Drug Test, Polygraph Examination, Physical Examination, Psychological Examination, and Background Investigation?

 

 

2.          Have you ever been convicted of any law violation?  (Include any plea of "guilty" or "no contest."  Exclude minor traffic violations.)  If yes, give details below.  Convictions do not necessarily preclude you from employment.

 

 

 

8.          If hired, will you engage in any other employment?  If yes, please explain in the space provided below.

 

 

3.          If you are in High School, do you have a valid Work Permit?

 

 

 

9.          Have you ever worked for Carlile’s before?  If yes, please list positions held and approximate dates of employment in the space provided below.

 

 

4.          Have you ever agreed to or been required to take a drug and/or alcohol test which resulted in a positive test within the past three years?

 

 

 

10.       Do you have reliable transportation to work?

 

 

5.          If you are under the age of 18, can you provide an age verification form?   If you are over the age of 18, write "N/A" for "Not Applicable

 

 

 

11.       If hired, can you furnish proof that you are eligible to work in the United States?  If no, please explain in the space provided below.

 

 

6.          Are you able to perform the essential functions of the position for which you have applied with or without reasonable accommodation?

 

 

 

12.       Is there anything else that we need to be aware of if we hire you? Explain below

 

 

         SPACE FOR DETAILED ANSWERS.  Please indicate the item number and page # to which the explanation applies and be certain that you give complete detailed information.

 

 

 

 

 

 

 _______________

 

 

EMPLOYMENT HISTORY

            List all present and past employment.   Applicants must provide 5 consecutive years of employment history.  Please use supplemental sheet if more space is needed.  If submitting résumé, please also include all information requested on this application.

 

Present or Last Employer

 

Employer Address:

 

 

Dates of Employment:

From                            To        _________            Mo/Yr.                        Mo/Yr.                             

Salary or Earnings:

Job Title:

  

 

Description of Duties:

 

Reason for leaving:

Next to Last Employer

 

Employer Address:

 

 

Dates of Employment:

From                            To        _________            Mo/Yr.                        Mo/Yr.                             

Salary or Earnings:

Job Title:

  

 

Description of Duties:

 

Reason for leaving:

 

 

EDUCATION

 

High School diploma or GED: Yes  No    Higher Education: Circle highest grade completed 13   14   15   16    17   18

                                                                                                                                    Undergraduate       Graduate

Diploma/Degree obtained/Major Field of Study: 

 

Names/Address (College, University or Business/Vocational School)

Official transcripts may be required

Did you Graduate?

Degree/Major

 

 

 

 

 

 

 

 

 

DRIVER'S LICENSE

 

Do you hold a valid driver’s license?  Yes        No              State Licensed in               __________________       

 

Driver’s License Number________________________

__________________________________________________________________________________________________________

 

PROFESSIONAL REFERENCES (Do not include friends or relatives)

 

NAME

ADDRESS

TELEPHONE

LENGTH AND TYPE

OF ACQUAINTANCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I have read, understand, and by my signature, consent to these and all statements contained within this application.

 

 

   Signature:                                                                                                   Date: