Employment Application

Position applied for:

Date of Application:

How did you learn about us?:

Friend

Walk-In

Employment Agency

Relative

Other:

Last name:

First Name:

Middle Name:

Address:

City:

State:

Zip Code:

Telephone Number(s):

Email Address:

--1--

Employer:

Dates Employed:

Address:

Telephone Number(s):

Job Title:

Supervisor:

Hourly Rate / Salary:

Reason for leaving:

Work performed:

--2--

Employer:

Dates Employed:

Address:

Telephone Number(s):

Job Title:

Supervisor:

Hourly Rate / Salary:

Reason for leaving:

Work performed:

--3--

Employer:

Dates Employed:

Address:

Telephone Number(s):

Job Title:

Supervisor:

Hourly Rate / Salary:

Reason for leaving:

Work performed:

--4--

Employer:

Dates Employed:

Address:

Telephone Number(s):

Job Title:

Supervisor:

Hourly Rate / Salary:

Reason for leaving:

Work performed:

List professional, trade, business or civic activities and offices held.
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status

Name and Address

Course of Study

Years Completed

Diploma / Degree

Elementary School

High School

Undergraduate College

Graduate Professional

Other (Specify)

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

Fluent

Good

Fair

Speak

Read

Write

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Describe any job-related training received in the United States military.

I certify that answers given herein are true and completed 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.

Click here to accept Todays Date

If you are under 18 years of age, can you provide required proof of your eligibility to work?	Yes No
Have you ever filed an application with us before?	Yes No If Yes, give date:
Have you ever been employed with us before?	Yes No If Yes, give date:
Are you Currently employed?	Yes No
May we contact your present employer?	Yes No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (proof of citizenship or immigration will be required upon employment)	Yes No
On what date would you be available for work?
Are you available to work:
Are you Currently on "Lay-Off" status and subject to recall?	Yes No
Can you Travel if the job requires it?	Yes No
Have you been convicted of a felony within the last 7 years? (Conviction will not nessarily disqualify an applicant from employment)	Yes No
If Yes, Please Explain:

Dixon Engineering, Inc.

Employment Application