Position Applied For:

Position:

How did you learn about us? AdvertisementFriendWalk-inEmp. AgencyRelativeOther

If other, please specify

Legal Name

First name*

Middle name

Last Name*

Address

City*

State*

Zip

Your Email (required)

Telephone Number*

Social Security Number*

Have you ever been employed with us before? YesNo

If Yes, give date (YYYY-MM-DD):

Are you currently employed?* YesNo

May we contact your present employer?* YesNo

On what date would you be available for work?*(YYYY-MM-DD)

Are you available to work Full TimePart TimeTemporary

Are you currently on "Lay-Off" status and subject to recall?* YesNo

Have you been convicted of a felony within the last seven years?* YesNo

(Conviction will not necessarily disqualify an applicant from employment).

If Yes, please explain:

Education*

Elementary School (choose highest year completed):
None45678

High School (choose highest year completed):
None9101112

College (choose highest year completed):
None1234

School Name & Location:

Describe College Course of Study:

Describe any specialized training skills, and extra-curricular activities:

State any additional information you feel may be helpful to us in considering your application:

Indicate any foreign languages you can speak, read, and/or write:

List professional, trade, business, or civic activities and offices held.
You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, or handicap or other protected status:

References:
Give name, address, and telephone number of three references who are not related to you and are not previous employers.

Reference 1
Name

Address

Telephone

Reference 2
Name

Address

Telephone

Reference 3
Name

Address

Telephone

Are you physically or otherwise unable to perform the duties of the job for which you are applying? YesNo

Special Skills and Qualifications :
Summarize special job-related skills and qualifications acquired from employment or other experience.

Employment Experience :
Start with your present or last job. Include any job-related military service assignments and voluntary activities. You may exclude organizations which indicate race, color, religion, gender, nationality, handicap, or other protected status.

Employer 1:

Work Performed:

Dates Employed From(YYYY-MM-DD): to
Telephone Number:

Employer 2:

Work Performed:

Dates Employed From(YYYY-MM-DD): to
Telephone Number:

Employer 3:

Work Performed:

Dates Employed From(YYYY-MM-DD): to
Telephone Number:

APPLICANT'S STATEMENT
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any application wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I understand that I am required to abide by all rules and regulations of the employer:

I Accept This Applicant's Statement:*

APPLICATION FOR EMPLOYMENT EQUAL OPPORTUNITY EMPLOYER
If the applicant meets the minimum criteria for the position applied, he may be invited for one or more personal interviews by either two officers of the Company, an officer and agent of the Company designated by the president or two agents of the Company designated by the president. An offer of employment may be extended to the person the Company in its sole discretion determines is best suited for the position applied based on such factors as his or her employment history, attitude, experience or any other qualification that is clearly job related. However, there is no guarantee of an offer of employment if the best suited of the applicants does not measure up to the standards expected from the applicant based on his or her application and interview(s).

The Company is an Equal Opportunity Employer. The Company will not discriminate in its hiring practices either on the basis of any applicant's age, gender, race, creed, color, religion, national origin, sexual preference, disability or any other civil rights protection not specifically enumerated herein, and will encourage applications from individuals from diverse backgrounds.

Authorization to Investigate Employment History

This form is attached to and incorporated into my application to DiRecManagement, Inc. for employment, as is fully set forth therein.

I hereby authorize DiRecManagement, Inc. to contact my former employers whose names I have provided for the purposes of verifying my employment dates, the reason(s) I left employment, and assessment of my performance as an employee and my salary at the time my employment terminated. No information will be requested that would be in violation of the Equal Employment Opportunity Act. I understand that the information obtained will be used in DiRecManagement, Inc.’s decision to offer me employment. If DiRecManagement, Inc. learns from its authorized investigation that any information I have provided is false, I will not be considered for employment. I further understand that I have the right to seek legal counsel before signing this authorization, but that my application for employment will not be deemed complete until I have signed it, and that DiRecManagement, Inc. will not consider an incomplete application.

I authorize DiRecManagement to Investigate my Employment History:*