Employment Application - Cornerstone Towers

Application Note

This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, color, age, creed, national origin, sexual orientation, military reserve membership, ancestry, religion, height, weight, use of a guide or support animal because of blindness, deafness or physical handicap, or the presence of disabilities. A felony conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. After an offer of employment, and prior to reporting to work, you may be required to submit to a medical review. Depending on company policy and the needs of the job, you will be required to complete a medical history form and may be required to be examined by a medical professional designated by the company.

Today's Date:	(mm/dd/yy)
Name:
Social Security Number:
Home Phone:	-
Work Phone:	-
Email:
Current Address:
City:	State: Zip:
Prior Address:
City:	State: Zip:

Availablity

For which position are you applying?

What date can you start?

What category would you prefer?

Full-time	Temporary
Part-time	Labor pool

For which schedules are you available?*

Weekdays	Nights
Weekends	Overtime
Evenings	Shift
Other	* reasonable efforts will be made to accommodate religous beliefs and practices

Job-Related Skills

Yes No	If the job requires, do you have the appropriate valid drivers license? Name on license: DL#: Type: State of issue:
Yes No	Have you had any moving violations? Please describe :
	Please list any other skills, licences or certificates that may be job-related or that you feel would be of value to this job or company:
Yes No	Have you been given a job description or had the essential functions of the job explained to you?
Yes No	Do you understand these essential functions?
Yes No	Can you perform the essential functions of this job with or without reasonable accomodation?
	List any languages in which you are fluent:

Security

	List states and counties of residence for the past seven years:
Yes No	Have you used any names or Social Security Numbers other than given above? If so, please list in comments, below.
Yes No	Have you been convicted of a crime in the past seven years? If so, please describe in the boxes below. (Conviction will not necessarily be a bar to employment. In accordance with company policy and applicable state and federal laws, factors such as age at time of the offense, remoteness of the offense, time since last conviction, nature of the job sought and rehabilitation effort will be reviewed.)

	Incident	City / State	Charge
1.
2.

Comments

Previous Emloyers

PLEASE NOTE: Your application will not be considered unless every question in this section is answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are critical. Ask for a phone book or call information if necessary. FOR EMPLOYERS OUTSIDE THE U.S., A CURRENT FAX NUMBER IS MANDATORY.

MOST RECENT EMPLOYER
Yes No	Are you currently working for this employer?
Yes No	If yes, may we contact?

Company Name:
Location:	City State
Phone:	-
Fax:	-
Supervisor Name:

Dates Employed:	From To
Job Title:
Duties:
Salary:	per
Reason for Leaving?

SECOND MOST RECENT EMPLOYER
Company Name:
Location:	City State
Phone:	-
Fax:	-
Supervisor Name:

Dates Employed:	From To
Job Title:
Duties:
Salary:	per
Reason for Leaving?

THIRD MOST RECENT EMPLOYER
Company Name:
Location:	City State
Phone:	-
Fax:	-
Supervisor Name:

Dates Employed:	From To
Job Title:
Duties:
Salary:	per
Reason for Leaving?

References
Include only individuals familiar with your work ability. Do not include relatives.

	Name	Address / Phone	Years Known / Relationship
1.
2.

Education
NOTE: Do not fill out any part of this section you believe to be non-job related.

Please circle highest grade completed:
7 8 9 10 11 12 13 14 15 16 16+

If your school records are under a different name than listed on page 1, please enter that name:

High School
Name:
Location:
Graduate:	Yes No
Degree:

College
Name:
Location:
Graduate:	Yes No
Degree:

Other
Name:
Location:
Graduate:	Yes No
Degree:

Certification and Release

I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejections of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.