(716) 771-1962
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4534 Clinton St, West Seneca, NY 14224
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Employment Application
We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law.
Personal Information
First Name
*
Last Name
*
Middle Name
Current Address
Street Address
*
City
*
State
*
Zip
*
Alternate Address
Street Address
City
State
Zip
Contact Information
Home Phone
*
Mobile Phone
Email
*
Position
Position Sought
*
Available Start Date
*
Desired Pay Range
*
Are you Currently Employed?
*
Yes
No
Education
High School (Name & Location)
Major
Did You Graduate?
Yes
No
College or University (Name & Location)
Major
Did You Graduate?
Yes
No
Currently Attending
Specialized Training, Trade School (Name & Location)
Major
Did You Graduate
Yes
No
Currently Attending
Other Education (Name & Location)
Major
Did You Graduate
Yes
No
Currently Attending
Skills
Please list your areas of highest proficiency, special skills or other items that may contribute to your abilities in performing the above-mentioned position.
Previous Experience
Most Recent Employer
Company (Name & Location)
Start Date
End Date
Role/Title
Job Notes, Tasks Performed & Reason for Leaving?
Employer
Company (Name & Location)
Start Date
End Date
Role/Title
Job Notes, Tasks Performed & Reason for Leaving?
Employer
Company (Name & Location)
Start Date
End Date
Role/Title
Job Notes, Tasks Performed & Reason for Leaving?
Personal References
Reference One
Full Name
*
Address
*
Phone
*
Occupation
*
Years Known
*
Reference Two
Full Name
*
Address
*
Phone
*
Occupation
*
Years Known
*
Reference Three
Full Name
*
Address
*
Phone
*
Occupation
*
Years Known
*
Availability
How Many Hours Are You Interested In Working?
*
Days Available
*
Misc. Questions
Drivers Licence Number
*
License State
*
Expiration Date
*
Are You a Veteran of The US Military?
*
Yes
No
Signature
I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize investigations of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given on my application or interview may result in termination.
Signature
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Date
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