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Application for Employment

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job-related medical condition or handicap, or any other legally protected status.

Position(s) Applied For: Date of Application:
How Did You Learn About Us? Advertisement Friend i Walk-In Employment Agency iRelative Other
Last Name: First Name: Middle Name:
Address: City: State: Zip:
Social Security Number: - -
Telephone: - -
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? Date filed:	Yes	No
Have you ever been employed with us before? Date Employed:	Yes	No
Are you currently employed?	Yes	No
If yes, 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 status will be required upon employment.	Yes	No
On what date would you be available for work?
Are you available to work: Full Time Part Time Shift Work Temporary
Are you currently on "lay-off" status and subject to recall?	Yes	No
Can you travel if a job requires it?	Yes	No
Have you been convicted of a felony within the last seven years? Conviction will not necessarily disqualify an applicant from employment. If yes, please explain:	Yes	No

Education
	Elementary School	High School	Undergraduate College / University	Graduate / Professional
School Name and Location
Years Completed
Diploma / Degree
Describe Course of Study
Describe any specialized training, apprenticeship, skills, and extra-curricular activites
Describe any honors you have received
State any additional information you feel may be helpful to us in considering your application

Indicate any foreign languages you can speak or write
	FLUENT	GOOD	FAIR
SPEAK
READ
WRITE

List any professional, trade, business, or civic activities and offices held.

References

Give name, address, and telephone number of three references who are not related to you and are not previous employers.

Name Address Phone - -
Name Address Phone - -
Name Address Phone - -

Have you ever had any training in the United States military? If yes, please explain:	Yes	No
Are you physically or otherwise unable to perform the duties of the job for which you are applying?	Yes	No

Employment
Employer:	Employed From:	Employed To:
Address:	City:	State: Zip:
Job Title:		Supervisor:
Work Performed:
Reason for Leaving:

Employer:	Employed From:	Employed To:
Address:	City:	State: Zip:
Job Title:		Supervisor:
Work Performed:
Reason for Leaving:

Employer:	Employed From:	Employed To:
Address:	City:	State: Zip:
Job Title:		Supervisor:
Work Performed:
Reason for Leaving:

Employer:	Employed From:	Employed To:
Address:	City:	State: Zip:
Job Title:		Supervisor:
Work Performed:
Reason for Leaving:

Special Skills and Qualifications

Summarize special skills and qualifications acquired from employment or other experience.

Applicant's Statement

I certify that answers given herein are true and complete 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 that time period should inquire as to whether applications are being accepted at that time.

I hereby understand 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.

Signature of Applicant:

Date:

Release Statement for Employment Certification

I hereby give Meade and Associates, Inc. the right to make a thorough investigation of my past employment and education. I release from all liability, all persons, companies, schools, and corporations supplying such information. I indemnify Meade and Associates, Inc. against any liability which might result from making such investigations. I agree that Meade and Associates, Inc. may obtain a consumer report or other information regarding me. I understand that any false answers or statements or implications made by me in this application or other required documents shall be considered sufficient cause for denial of employment or discharge.

Additionally, I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between Meade and Associates, Inc. and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon Meade and Associates, Inc. unless made in writing. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and Meade and Associates, Inc. retains a similar right, with or without cause.

Signed By:

Date:

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