Position applied for
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Summer 2024 Internship
Fall 2024 Internship
Date of Application
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Name
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First Name
Last Name
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Main Phone Number
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(###)
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Alt. Phone Number
(###)
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Email
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Name of Employer (Company)
Supervisor's Name
First Name
Last Name
May we contact?
Employer's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Employer's Phone
(###)
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Employment Start Date
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DD
YYYY
Employment End Date
MM
DD
YYYY
Job Title and Duties
Reason for leaving
Name of Employer (Company)
Supervisor's Name
First Name
Last Name
May we contact?
Employer's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Employer's Phone
(###)
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Employment Start Date
MM
DD
YYYY
Employment End Date
MM
DD
YYYY
Job Title and Duties
Reason for leaving
Name of Employer (Company)
Supervisor's Name
First Name
Last Name
May we contact?
Employer's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Employer's Phone
(###)
###
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Employment Start Date
MM
DD
YYYY
Employment End Date
MM
DD
YYYY
Job Title and Duties
Reason for leaving
Have you ever been involuntarily terminated or asked to resign from any job?
If yes, please explain.
Please explain any gaps in your employment history.
Please list any other experience, job-related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualifications for employment.
High School Name
Diploma/degree?
Area of Study
Specialized training, skills, or extracurricular activities
College/University Name
Diploma/degree?
Area of Study/Major
Specialized training, skills, or extracurricular activities
Graduate/Professional School Name
Diploma/degree?
Area of Study/Major
Specialized training, skills, or extracurricular activities
Trade School Name
Diploma/degree?
Area of Study/Major
Specialized training, skills, or extracurricular activities
Reference #1: Name and Title
Relationship
Phone Number or Email
Reference #2: Name and Title
Relationship
Phone Number or Email
Reference #3: Name and Title
Relationship
Phone Number or Email
Relationship and years acquainted
Phone Number or Email
Personal Reference #2: Name and Title
Relationship and years acquainted
Phone Number or Email
Personal Reference #3: Name and Title
Relationship and years acquainted
Phone Number or Email
Have you ever used another name?
Is any additional information relative to name changes, use of an assumed name, or nickname necessary to enable a check on your work and educational record?
If yes to either of the above, please explain:
Have you ever worked for us before?
If yes, please provide dates and position:
Do you have friends and/or relatives working for this company?
If yes, name(s) and relationship(s):
On what date are you available to begin work?
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Days/hours available to work:
Are you available to work?
If hired, would you have a reliable means of transportation to and from work?
Can you travel if the position requires it?
Can you relocate if the position requires it?
Are you at least 18 years old?
Note: If under 18, hire is subject to verification that you are of minimum legal age.
If hired, can you present evidence of your identity and legal right to work in this country?
Are you able to perform the essential job functions of the job for which you are applying with or without reasonable accommodation?
Note: We comply with the Americans with Disabilities Act and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions.
I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the company any and all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers, and all other persons, corporations, partnerships, and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure.
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In the event of my employment with the company, I understand that I am required to comply with all rules and regulations of the company.
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If hired, I understand and agree that my employment with the company is at will and that neither I nor the company is required to continue the employment relationship for any specific term. I further understand that the company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.
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I understand that the safety of employees is extremely important to the company and that the company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on- the-job safety and health.
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I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
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I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration law requires me to complete an I-9 Form in this regard.
I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed, and the remainder of this Agreement shall be enforceable.
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Digital Signature (Type Name)
Today's Date
MM
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