Employment Application | Association Headquarters

Personal

First

Middle

Last

Personal E-Mail Address

Address

City/Town

State/Province

ZIP/Postal Code

Home Telephone

Have you ever applied for employment with us?

Yes

No

Month and Year

Position Desired

Salary Range Desired

Are you available for full-time work?

Yes

No

What hours are you available?

Are you over 18 years of age?

Yes

No

Are you legally eligible for employment in the United States?

Proof of identity and employment eligibility will be required upon employment.

Yes

No

How did you learn of this position?

Please notify in case of emergency:

Education

Name and Location of School	Course of Study	Did You Graduate?	Degree or Diploma
College		Did You Graduate?
High School		Did You Graduate?
Elementary		Did You Graduate?
Other		Did You Graduate?

Organizations

Membership In Professional Or Civic Organizations

(Exclude those which may disclose your race, color, religion or national origin.)

Membership In Professional Or Civic Organizations
Membership In Professional Or Civic Organizations

Military

Complete this section if you served in the U.S. Armed Forces.

Describe your duties and any special training:

Branch of Service

Period of Duty

From:

To:

Rank at Discharge

Employment

(Most Recent Employment First)

Employer
Company Name Address Telephone Employed From Employed To Name and Title of Supervisor Job Title Description Reason for Leaving

Do you authorize us to secure confidential information on your performance and ability from:

Former Employers

Yes

No

Your Present Employer

Yes

No

Additional Skills

Please state below any facts or details concerning your experience and training which explain more fully your qualifications for the position for which you are applying.

References

Name	Address	Phone Number	Occupation	Operations
Name (other than relative)	Address	Phone Number	Occupation

We are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, creed, color, national origin, nationality, ethnicity, ancestry, age, sex (including pregnancy), family status, marital/civil union status, religion, domestic partnership status, affectional or sexual orientation, gender identity and expression, atypical hereditary cellular or blood trait, genetic information, liability for military service, and mental or physical disability (including perceived disability, and AIDS and HIV status), language, national origin, political affiliation, socio-economic status, and other characteristics that make our employees unique.

On entering employment, I agree to conform to the rules and regulations and acknowledge that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the company or myself. I further understand that I may be required to sign an Employment Agreement and a Confidentiality Agreement, which will be kept in my personnel file. I also understand that no policy, benefit, or procedure contained in any handbook creates an employment contract for any period of time, and no terms or conditions of employment contrary to the foregoing should be relied upon except for those made in writing by a designated officer of the company.

All of the information on this application is truthful and factual and it is my understanding that should any falsification or material omission be discovered, it will constitute grounds for non-acceptance or dismissal.

Signature

Sign above

We value diversity in our organization, and we are an equal opportunity employer. We do not discriminate against any applicant because of race, color, religion, sex, age, national origin, disability, or sexual orientation.