Application for Employment
Position Sought - Multiple Selections (hold shift key):
How did you learn about the position?
Name   Today's Date
Address City State Zip
Home Phone   Cell Phone Other Phone
Email Address:   Social Security Number
What date would you be able to start?   Desired Salary $
Are you a U.S. citizen, or are you otherwise authorized to work in the U.S. without any restriction? Yes   No
Have you ever been convicted of a felony? Yes   No
If yes, please describe circumstances:
Have you ever been involuntarily terminated or asked to resign from any position of employment? Yes   No
If yes, please describe circumstances:

Education

School Name 1 Location
Years Attended Major Degree Received Yes  No
School Name 2 Location
Years Attended Major Degree Received Yes  No
School Name 3 Location
Years Attended Major Degree Received Yes  No

Other training, certifications, or licenses held:

List other information pertinent to the employment you are seeking:

Employment (Most Recent First)

Employer 1   Job Title Supervisor
Dates Employed Position(s) Held
Address   City   State   Zip
Phone   Fax    Email Address
Starting Salary $  Ending Salary $
Duties Performed
Reason for Leaving

Employer 2   Job Title Supervisor
Dates Employed Position(s) Held
Address   City   State   Zip
Phone   Fax    Email Address
Starting Salary $  Ending Salary $
Duties Performed
Reason for Leaving

Employer 3   Job Title Supervisor
Dates Employed Position(s) Held
Address   City   State   Zip
Phone   Fax    Email Address
Starting Salary $  Ending Salary $
Duties Performed
Reason for Leaving

Employer 4   Job Title Supervisor
Dates Employed Position(s) Held
Address   City   State   Zip
Phone   Fax    Email Address
Starting Salary $  Ending Salary $
Duties Performed
Reason for Leaving

Acknowledgement and Authorization

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 applicant 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(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Please review your application for accuracy before submitting it to Yemanja Brasil.: