Employment Application - Mincey Marble

Employment Application

(All qualified applicants will be considered for employment without regard to race, color, religion, gender, national origin, age, disability, marital status, veteran status, or any other characteristic protected by law.)

APPLICANT INFORMATION

Last Name

First

M.I.

Date

Street Address

Apartment/Unit #

City

State

ZIP

Phone

E-mail Address

Date Available

Shift Preference

Desired Salary

Position Applied for

Are you legally eligible for employment in the United States?

YES

NO

Have you ever been employed by Mincey Marble?

YES

NO

Is there anything that would interfere with your ability to arrive to work each day?

YES

NO

Have you ever been convicted of a felony

in the last 7 years?

YES

NO

(conviction will not necessarily disqualify an applicant

from employment)

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

If yes, when?

Do you have friends/relatives who work here? YES

NO

If yes, explain

EDUCATION High School

From

To

College

From

To

Other

From

To

Address

Did you graduate? YES

NO

Address

Did you graduate? YES

NO

Address

Did you graduate? YES

NO

Degree Degree Degree

REFERENCES Please list three references (not relatives or employers). Full Name Address Full Name Address Full Name Address

Relationship Phone No.:

Relationship Phone No.:

Relationship Phone No.:

PREVIOUS EMPLOYMENT Company

Phone (

Address

Supervisor

Job Title

Starting Salary $

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

YES

NO

Company

Phone (

Address

Supervisor

Job Title

Starting Salary $

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

YES

NO

Company

Phone (

Address

Supervisor

Job Title

Starting Salary $

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

YES

NO

) Ending Salary $

) Ending Salary $

) Ending Salary $

MILITARY SERVICE Branch Rank at Discharge If other than honorable, explain

From

To

Type of Discharge

DISCLAIMER AND SIGNATURE

EEO Statement - Mincey Marble is an equal opportunity employer and does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Mincey Marble to hire me. If I am hired, I understand that either Mincey Marble or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Mincey Marble has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to Mincey Marble true and complete information on this application. No requested information has been concealed. I authorize Mincey Marble to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT

Signature

Date

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