Application for Employment Date:  * Applicant Name:  * Phone Number:  * Email Address: Address:  * City:  * State:  * Zip Code:  * Date of Birth:  * Employment Positions Position Applying for:  * Temporary work Regular part-time work Regular full-time work Days and Hours Available:  * Date available to start:  * Avaliable weekends Available evenings Salary Desired:  * Personal Information Have you ever applied to/ worked for The Springs? Yes No If yes please explain: Yes No Do you have any relatives friends or acquaintances for for The Springs? If yes state name and relationship:  * Are you over the age of 18? (If under 18 hire is subject to verification of minimum legal age.) Yes No If hired would you be able to present evidence of you U.S. citizenship or proof of your legal right to work in the United States? Yes No Are you able to perform the essential functions of the job for which you are applying either with/ without reasonable accomodation? Yes No If hired would we have your consent to do a background check an/ or random drug test? Yes No If answered no to any above questions please explain: Have you ever been convicted of a criminal offense (felony or misdemeanor)? Yes No If yes please describe the crime- state nature of the crime(s) when and where convicted and disposition of the case. (Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense the nature of the offense including any significant details that affect the description of the event and the surrounding circumstances and teh relevance of the offense to the position(s) applied for may however be considered.)   Education Training and Experience   High School: School name: School address: School city state zip Number of years completed: Did you graduate? Degree/ Diploma earned: College/ University School name: School address: School city state zip Number of years completed: Did you graduate? Degree earned: Military Branch: Rank in Military: Total years of service: Skills/Duties: Related details:   Additional Information Please add any additional training experience qualifications or skills which you feel should be brought to our attention in the case that they make you especially suited for working with us:   Employment History Are you currently employed? If yes may we contact current employer? Below please describe past and present employment positions dating back five years. Please account for all periods of unemployment.   Name of employer: Name of supervisor: Telephone number: Business type: Address: City State Zip Length of employment (Include dates): Position: Duties: Reason for leaving: May we contact this employer?   Name of employer: Name of supervisor: Telephone number: Address: City State Zip Length of employment: Position: Duties: Reason for leaving: May we contact this employer?   Name of employer: Name of supervisor: Telephone number: Business type: Address: City State Zip Length of employment: Position: Duties: Reason for leaving: May we contact this employer?   Any additional employment history up to 5 years:   References   List below two persons who have knowledge of your work performance within the last four years. Please include professional references only. Name: Telephone number: Occupation: Number of years acquainted:   Name: Telephone number: Occupation: Number of years acquainted Please Read and Initial Each Paragraph then Sign Below.   I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true and correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or if I am emplyed by this company terms for my immediate explusion from the company.  *   I understand that if I am employed my employment is not definite and can be terminated at any time either with or without prior notice and by either me or the company.  *   I permit the company to examine my references record of employment education record and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them without giving me prior notice of such disclosure. In addition I 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 examination or revelation.  *   Applicants Electronic Signiture:  * Date:  *   Security code:   * Do not enter anything in this field: