Applicant Information

Full Name:

Date:

Address:



Date Available: Social Security #:

Desired Salary:

Position Applying For:

Are you a citizen of the United States? YesNo

If not, are you authorized to work in the US? YesNo

Have you ever worked for this company? YesNo

If so, when?

Do you have a valid drivers license? YesNo

Have you ever been convicted of a felony? YesNo

If so, please explain:


Education

High School: Location:

Years attended: Did you graduate? YesNo


College: Location:

Years attended: Did you graduate? YesNo

If so, what degree was attained?


Other education: Location:

Years attended: Did you graduate? YesNo

If so, what degree or certification was attained?


References
Please list three personal references:

Name: Relationship:

Company: Phone:


Name: Relationship:

Company: Phone:


Name: Relationship:

Company: Phone:


Previous Employment

Company: Phone:

Location: Supervisor:

Job title:

Start salary: End salary:

Responsibilities:

Employment started: Employment ended:

Reason for leaving:

May we contact your supervisor? YesNo


Company: Phone:

Location: Supervisor:

Job title:

Start salary: End salary:

Responsibilities:

Employment started: Employment ended:

Reason for leaving:

May we contact your supervisor? YesNo


Company: Phone:

Location: Supervisor:

Job title:

Start salary: End salary:

Responsibilities:

Employment started: Employment ended:

Reason for leaving:

May we contact your supervisor? YesNo


Military Service

Branch: Service started: Service ended:

Rank at discharge: Type of discharge:

If other than honorable, please explain:


Disclaimer and Signature

I acknowledge that, from time to time, Martin Horn inc. may be required to submit certain information with regard to my employment or application to various state and federal government agencies. I hereby authorize Martin Horn inc. to provide such information, and release the company, and its owners from any liability resulting from submitting such information.

I understand and agree that, if employed by Martin Horn inc. , at all times my employment is “at will”, and that regardless of how long I may be employed by the company, I may be disciplined, laid-off, or dismissed at any time, with or without cause, and with or without notice. THIS IS NOT A CONTRACT OF EMPLOYMENT.

I understand that if offered employment that I will be tested for the presence of drugs and alcohol in my system and that any abnormalities will result in me being not eligible for employment. I also understand as part of continued employment if involved in an accident or presenting reasonable concern for drug or alcohol use I will be tested.

I acknowledge that Martin Horn inc. is an equal opportunity/affirmative action employer and my application will be considered based upon my qualifications only.

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I accept:


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