Job Application – Santa Maria, CA

Applicant Instructions
Incomplete applications will not be processed. This application will be considered active for 180 days. Any applicant wishing to be considered beyond this time period should submit another application.

Please note. This application is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all questions completely and accurately. False or misleading statements on this form are grounds for terminating the application process, or, if discovered after employment, terminating employment.

 

Applicant Information

    First Name (required)
    Middle Initial
    Last Name (required)
    Suffix
    Social Security Number(required)
    Address (required)
    City (required)
    State (required)
    Zip Code (required)
    Home Telephone
    Daytime Telephone
    Email

    Position Information

    Which position are you interested in?
    Desired Salary
    Willing to relocate?
    YesNo
    Comments
    Full-Time or Part-Time employment
    Full-TimePart-Time
    If Part-Time, how many hours per week are you available?
    What date are you available to start?
    Are you at least 18 years of age?
    YesNo

    Citizenship Information

    Are you prevented from being lawfully employed in this country due to a Visa or immigration status?
    YesNo

    Education Information

    High School Name
    City
    ST
    Receive High School Diploma?
    College/University
    City
    ST
    How many years of College have you completed?
    What is/was your course of study?
    What was your graduation date/projected graduation date?

    Job Related Skills

    List any languages other than English that you speak fluently:
    Mark all skills that apply
    Word Processing10 Key Adding Machine
    TypingWPM
    List all knowledge of computer programs
    List any other skills:
    List any licenses or certifications you have that you feel would be of value to this job or company

    Security

    Have you ever been bonded in prior employment?
    YesNo
    Have you ever been convicted of a misdemeanor or a felony?
    YesNo
    If Yes, please explain

    Background Authorization

    If I am interviewed and accept employment, I agree to allow company to investigate my background.
    YesNo

    Employment Experience

    Please go back 5 years, listing your most recent employer first. Include any gaps in employment and state the reason for no employment during that period.
    Employer
    Address
    City
    ST
    Zip Code
    Phone
    Job Title
    Supervisor
    Start Date
    End Date
    Starting Salary/Hourly Wage
    Ending Salary/Hourly Wage
    Reason for Leaving

    Employer
    Address
    City
    ST
    Zip Code
    Phone
    Job Title
    Supervisor
    Start Date
    End Date
    Starting Salary/Hourly Wage
    Ending Salary/Hourly Wage
    Reason for Leaving

    Employer
    Address
    City
    ST
    Zip Code
    Phone
    Job Title
    Supervisor
    Start Date
    End Date
    Starting Salary/Hourly Wage
    Ending Salary/Hourly Wage
    Reason for Leaving

    References

    Name, Address, Phone
    #Years Known
    Relationship

    Name, Address, Phone
    #Years Known
    Relationship

    Name, Address, Phone
    #Years Known
    Relationship
    I hereby certify that I have a genuine interest in being hired and that all of the foregoing statements are true and correct. I agree to assume a continuing responsibility to disclose additional or new information, called for by this Employment Application, but known to me only after this Application was completed, and understand that my failure to make such a disclosure, and that falsification of any of the information given herein, on any employment form or in any interview, are grounds for immediate termination, regardless of when such failure or falsification may be discovered.

    I also understand that my employment may be terminated at any time, with or without cause, without liability to me for salary, wages, or other benefits except as may have been earned up to date of the termination of services.