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Employment Application
Employment Application (1/23)
Applicant Information
Name:
Address:
City/State/Zip:
Phone:
Email:
Position Applied for:
Referred by:
Date Available:
Desired Salary:
Do you have a valid Driver's License?
Yes
No
Are you legally authorized to work in the United States?
Yes
No
Have you ever worked for this company?
Yes
No
If yes, when?
Have you ever been convicted of a felony?
Yes
No
If yes, please explain:
Education
High School:
Address:
Dates:
Did you graduate?
Yes
No
College:
Address:
Dates:
Did you graduate?
Yes
No
Degree:
Other:
Address:
Dates:
Did you graduate?
Yes
No
Degree/Certification:
References
Name:
Relationship:
Company:
Phone:
Name:
Relationship:
Company:
Phone:
Name:
Relationship:
Company:
Phone:
Previous Employment
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
Start Date:
End Date:
Reason for Leaving:
May we contact your previus supervisor for reference?
Yes
No
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
Start Date:
End Date:
Reason for Leaving:
May we contact your previus supervisor for reference?
Yes
No
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
Start Date:
End Date:
Ending Salary:
May we contact your previus supervisor for reference?
Yes
No
Military Service
Branch:
Dates of Service:
Rank at Discharge:
Type of Discharge:
If other than honorable, please explain:
Disclaimer and Signature
Affirmative Action/EEO Statement
XRI is an equal opportunity employer. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status, or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
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
Signature:
Date:
Resume
Max. file size: 32 MB.
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