Application for Employment
Location to which you want to apply?
PEORIA LAKE PLEASANT/HAPPY VALLEY
SCOTTSDALE NORTHSIGHT/RAINTREE
SCOTTSDALE SCOTTSDALE RD/SHEA
SCOTTSDALE SCOTTSDALE RD/MAYO
PEORIA 83RD AVE/THUNDERBIRD
HAPPY VALLEY
NORTERRA-I-17/HAPPY VALLEY
GLENDALE 59TH AVE/LOOP 101
GLENDALE 59TH AVE/PEORIA AVE
IRONWOOD & OCOTILLO
PHX CENTRAL 7TH ST/CAMELBACK
MCCORMICK RANCH HAYDEN/INDIAN BEND
BILTMORE FASHION PARK
QC POWER/RITTENHOUSE
ELLSWORTH & RIGGS
SURPRISE LOOP 303/BELL RD
GILBERT EAST HIGLEY/RAY
ARCADIA-44TH ST/INDIAN SCHOOL
GLENDALE 83RD AVE/UNION HILLS
SURPRISE-REEMS/BELL RD
CHANDLER ARIZONA AVE/OCOTILLO
CITYSCAPE-CENTRAL/JEFFERSON
AUSTIN TX
MESA SIGNAL BUTTE/BASELINE
SPRING TX
SOUTHLAKE TX
HIGHLAND VILLAGE TX
TUCSON WILMONT/BROADWAY BLVD
TUCSON I-19/IRVINGTON
TEMPE SOUTH PRIEST/WARNER
TUCSON ORACLE/INA
MESA NORTH-POWER/MCDOWELL
CHANDLER RURAL/RAY
SCOTTSDALE SCOTTSDALE RD/MCKELLIPS
MESA GILBERT RD/MCKELLIPS
MESA ALMA SCHOOL/US-60
CHANDLER DOBSON/WARNER
GILBERT GILBERT/WARNER
GILBERT VAL VISTA/PECOS
MESA GREENFIELD/US-60
AHWATUKEE-48TH ST./CHANDLER BLVD
DESERT RIDGE-TATUM/LOOP 101
CAVE CREEK/CACTUS
PARADISE VALLEY TATUM/CACTUS
AVONDALE DYSART/RANCHO SANTE FE
PHX NORTH-7TH ST/BELL
PHX 32ND ST/BELL
Position(s) applied for:
Date of Application:
First Name:
Middle Name:
Last Name:
Address
City:
State:
Zip Code:
Phone #:
Mobile/Cell/Other Phone #:
E-mail Address:
If you are under 18, and it is required, can you furnish a work permit?
Yes
No
If No, please explain:
Have you ever been employed here before?
Yes
No
If Yes, give dates and positions:
Are you legally eligible for employment in this country?
Yes
No
Date available for work:
What is your desired salary range?:
Type of employment desired:
Full-time
Part-time
Temporary
Seasonal
Educational Co-op
Are you able to meet the attendance requirements of the position?
Yes
No
Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?
Yes
No
If Yes, please provide dates and details:
Answering "yes" to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness, and nature of the violation, rehabilitation, and position applied for will be taken into account.
Driver's License # (if driving is an essential job function):
State:
Employment History
Provide the following information for your past four (4) employers, assignments, or volunteer activities, starting with the most recent.
From:
To:
Employer:
Phone #:
Starting Job Title:
Final Job Title:
Address:
Immediate Supervisor and Title:
Summary of Work Performed and Job Responsibilities:
May we contact for reference?
Yes
No
Later
Reason for Leaving:
Starting Rate/Salary:
$:
Per:
Final Rate/Salary:
$:
Per:
From:
To:
Employer:
Phone #:
Starting Job Title:
Final Job Title:
Address:
Immediate Supervisor and Title:
Summary of Work Performed and Job Responsibilities:
May we contact for reference?
Yes
No
Later
Reason for Leaving:
Starting Rate/Salary:
$:
Per:
Final Rate/Salary:
$:
Per:
From:
To:
Employer:
Phone #:
Starting Job Title:
Final Job Title:
Address:
Immediate Supervisor and Title:
Summary of Work Performed and Job Responsibilities:
May we contact for reference?
Yes
No
Later
Reason for Leaving:
Starting Rate/Salary:
$:
Per:
Final Rate/Salary:
$:
Per:
From:
To:
Employer:
Phone #:
Starting Job Title:
Final Job Title:
Address:
Immediate Supervisor and Title:
Summary of Work Performed and Job Responsibilities:
May we contact for reference?
Yes
No
Later
Reason for Leaving:
Starting Rate/Salary:
$:
Per:
Final Rate/Salary:
$:
Per:
Skills and Qualifications
Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Educational Background (if job-related)
High School:
Number of Years Completed:
Did You Graduate?
Course of Study:
College:
Number of Years Completed:
Did You Graduate?
Major
Degree
Course of Study:
Other:
Number of Years Completed:
Did You Graduate?
Course of Study:
References
1-Name:
Telephone:
Number of Years Known
2-Name:
Telephone:
Number of Years Known
3-Name:
Telephone:
Number of Years Known
Applicant Statement
I certify that all information I have provided to apply for and secure work with the employer is true, complete, and correct.
I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect will be sufficient cause to (i) cancel further consideration of this application or (ii) immediately discharge me from the employer's service, whenever it is discovered.
I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives for seeking, gathering, and using such information in the employment process and all other persons, corporations, or organizations for furnishing such information about me.
I understand that the employer does not unlawfully discriminate in employment, and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state, or federal law.
I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary, and that no implied, oral, or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
Do not sign until you have read the above applicant statement.
I certify that I have read, fully understand, and accept all terms of the foregoing Applicant Statement.
Do you agree to the terms above?
Select one...
Yes
No
Date:
Thank you! Your submission has been received!
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