Employment Application

Serving Northeast Pennsylvania

Applicant to complete all information requested. In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, martial status, veteran status, non-job related disability, or any other protected group status.

PERSONAL INFORMATION
Date of Application:
Position(s) Applying for:
Name(first/middle/last):
Present Address (street):
City:
State:		Zip:
Previous Address (street):
City:
State:		Zip:
Phone Number:
Alt. Phone Number:
Email:
Do you have a legal right to be employed in the United States?		YES (proof required) NO
Are you over the age of 18?		YES NO
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
Date Available for work:
What is your desired salary range?
Are you available to work:
Full-Time Part-Time Temporary
Can you travel if a job requires it?		YES NO
Do you have a valid driver's license?		YES NO
Have you ever been convicted of a felony?		YES NO
EDUCATIONAL BACKGROUND
HIGH SCHOOL
Name and City:
Did you graduate?		YES NO
Course or Major:
COLLEGE
Name and City:
Did you graduate?		YES NO
Course or Major:
TECHNICAL SCHOOL
Name and City:
Did you graduate?		YES NO
Course or Major:
OTHER (SPECIFY)
Name and City:
Did you graduate?		YES NO
Course or Major:
EMPLOYMENT EXPERIENCE
Specialized Skills: Describe any specialized training, apprenticeship, skill, and extra-curricular activities:

Other Skills:
Terminal PC/MAC Spreadsheet Word Processing
WPM:
Production/Mobile Machinery (list):

Other Specialized Skills:

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

State any additional information you feel may be helpful to us in considering your application.

EMPLOYMENT HISTORY
Employer #1:
Address:
Phone Number 1:
Phone Number 2:
Phone Number 3:
Job Title:
Supervisor:
Reason for Leaving:
Dates Employed:		from to
Hourly Rate/Salary:		starting final
Work Performed:
Employer #2:
Address:
Phone Number 1:
Phone Number 2:
Phone Number 3:
Job Title:
Supervisor:
Reason for Leaving:
Dates Employed:		from to
Hourly Rate/Salary:		starting final
Work Performed:
Employer #3:
Address:
Phone Number 1:
Phone Number 2:
Phone Number 3:
Job Title:
Supervisor:
Reason for Leaving:
Dates Employed:		from to
Hourly Rate/Salary:		starting final
Work Performed:
REFERENCES
1.
Name:
Phone Number:
Address:
City:
State:		Zip:
Relationship to Applicant:
2.
Name:
Phone Number:
Address:
City:
State:		Zip:
Relationship to Applicant:
3.
Name:
Phone Number:
Address:
City:
State:		Zip:
Relationship to Applicant:
APPLICANT'S STATEMENT
I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as necessary to arrive at an employment decision. This application for employment shall be considered active for a period of time not to exceed 60 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 Damage Control, Inc. 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 at Damage Control, Inc. 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 Damage Control, Inc.
Signed by:
Date: