Sample Application For Employment
KAYTON INTERNATIONAL, INC. 2630 State Hwy 14 1211 W 2nd West Highway 275 PO Box 308 PO Box 220 PO Box 85 Albion, NE 68620 Crofton, NE 68730 Neligh, NE 68756 402-395-2181 402-388-4375 402-887-4118 SEQ CHAPTER \h \r 1Application for EmploymentABOUT THE COMPANYThank you for your interest in applying for a job with Kayton International, Inc. Because of our commitment to offering the highest possible satisfaction to our customers, we are only interested in hiring the best. We want to have a complete understanding of your qualifications, motivations and interests, so that we can make careful and deliberate hiring decisions that will benefit both the Company and our employees. Please answer the following questions honestly, completely and thoughtfully. This application must be completed in full, even if you are attaching a resume. Incomplete applications will not be considered. The Company is an Equal Opportunity Employer and do not discriminate on the basis of race, color, religion, sex, national origin, age, marital or veteran status, handicap or disability, or any other legally protected classification.Date of application ______________________PERSONAL INFORMATIONName: __________________________________________________________________________________________________________________ Last Name First Name Middle InitialIf you have ever worked under another name, please identify: ______________________________________________________________________Address: ________________________________________________________________________________________________________________City ______________________________________________________________ State ____________________ Zip Code ____________________Home Telephone: (_____) ________________________________________ Other Telephone: (_____) ___________________________________Social Security No.:________-_______-_____________If you are under 18 years of age, do you have a work permit? [ ] Yes [ ] NoCan you, after employment, submit verification of your legal right to work in the United States? [ ] Yes [ ] NoHave you ever been discharged or asked to resign by an employer? [ ] Yes [ ] NoIf yes, please explain:______________________________________________________________________________________________________________________________________________________________________________________________________________________________Have you ever been convicted of a crime, other than minor traffic violations? [ ] Yes [ ] NoIf yes, please explain:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________Note: A conviction record will not necessarily be a bar to employment. Factors such as age, time of offense, seriousness and nature of violation and rehabilitation will be considered.Have you ever been bonded? [ ] Yes [ ] NoIf you are applying for a position that requires driving, please complete the following information:Do you have a valid operator’s or commercial driver’s license (CDL)? [ ] Yes [ ] NoList all states (include corresponding license number(s) in which you are licensed:________________________________________________________________________________________________________________________Have you had any accidents in the last five years? [ ] Yes [ ] NoIf yes, please give details:___________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Has your driver’s license ever been suspended, revoked, denied or canceled? [ ] Yes [ ] NoIf yes, please give details:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________YOUR EDUCATION AND TRAININGPlease circle highest grade completed:1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 1 2 3 4Grade School High School College Trade/TechWhat was the last school you attended?________________________________________________________________________________________What extracurricular activities did you participate in, or special skills did you acquire, at the above-circled school(s) which might be helpful with the job for which you are applying?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________YOUR MILITARY EXPERIENCE (optional)Have you ever been in the United States Armed Services? [ ] Yes [ ] No What branch?_______________________________________ Describe any skills you acquired in the Service which would be useful to the job for which you are applying:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Rank upon discharge:______________________________________________________________________________________________________YOUR JOB INTERESTSPosition desired:__________________________ Date you can start to work:___________________What starting salary or wage do you expect? $_______ / hour $_______ / week $_______ / monthAre you available for full-time work? [ ] Yes [ ] No Are you available for part-time work? [ ] Yes [ ] NoAre you familiar with a farm machinery, industrial or lawn & garden dealership? [ ] Yes [ ] NoPlease explain:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How did you learn of this job opening?_______________________________________________________________________________________________________________________________________________________________________________________________________________Do you know anyone who works here? [ ] Yes [ ] No Who? ____________________________________________________________________What kind of work are you looking for?________________________________________________________________________________________________________________________________________________________________________________________________________________Why are you changing jobs (answer only if appropriate)?__________________________________________________________________________________________________________________________________________________________________________________________________Why would you like to work at The Company?__________________________________________________________________________________________________________________________________________________________________________________________________________YOUR WORK EXPERIENCEBeginning with your present or more recent employer, describe your employment experiences below:Are your presently employed? [ ] Yes [ ] No Are you on layoff or subject to recall? [ ] Yes [ ] No1.Present or last employer:____________________________________________________________________________________________Address:________________________________________________________________________________________________________Kind of business:__________________________________________________________ Phone: _________________________________Starting position:_________________________________________________________________ Pay: $___________________________Final position:___________________________________________________________________ Pay: $___________________________Dates employed: From:____________ To:____________ Name & Title of Supervisor:__________________________________________Description of your work and responsibilities:___________________________________________________________________________________________________________________________________________________________________________________________Reason for leaving:________________________________________________________________________________________________Will you receive a satisfactory reference from this employer? [ ] Yes [ ] No - Please explain:________________________________________________________________________________________________________________________________________________________________________________________________________________________________May we contact your present employer at this time? [ ] Yes [ ] No - Please explain:____________________________________________2.Next previous employer:____________________________________________________________________________________________Address:________________________________________________________________________________________________________Kind of business:________________________________________________ Phone: ___________________________________________Starting position:_____________________________________________________________ Pay: $_______________________________Final position:_______________________________________________________________ Pay: $_______________________________Dates employed: From:____________ To:____________ Name & Title of Supervisor:__________________________________________Description of your work and responsibilities:___________________________________________________________________________________________________________________________________________________________________________________________Reason for leaving:________________________________________________________________________________________________Will you receive a satisfactory reference from this employer? [ ] Yes [ ] No - Please explain:________________________________________________________________________________________________________________________________________________________________________________________________________________________________May we contact your present employer at this time? [ ] Yes [ ] No - Please explain:_________________________________________3.Next previous employer:____________________________________________________________________________________________Address:________________________________________________________________________________________________________Kind of business:________________________________________________ Phone: ___________________________________________Starting position:____________________________________________________________ Pay: $________________________________Final position:______________________________________________________________ Pay: $________________________________Dates employed: From:______________ To:____________ Name & Title of Supervisor:________________________________________Description of your work and responsibilities:___________________________________________________________________________________________________________________________________________________________________________________________Reason for leaving:________________________________________________________________________________________________Will you receive a satisfactory reference from this employer? [ ] Yes [ ] No - Please explain:________________________________________________________________________________________________________________________________________________________________________________________________________________________________May we contact your present employer at this time? [ ] Yes [ ] No - Please explain:____________________________________________Please check any of the following areas in which you have had actual experience:Service Department[ ] Service manager[ ] Shop foreman[ ] Tractor technician[ ] Implement technician[ ] Hydraulics technician[ ] Small engine technician[ ] Machine set-up[ ] Electrician[ ] Electronics[ ] Diesel technician[ ] Refrigeration[ ] Painting[ ] Truck driver[ ] WeldingSales Department[ ] Sales manager[ ] Farm equipment sales[ ] new [ ] used[ ] Construction equipment sales[ ] new [ ] used[ ] Outdoor power equipment sales[ ] new [ ] used[ ] Truck sales[ ] Auto sales Other[ ] Janitor[ ] Carpenter[ ] Building maintenance[ ] WatchmanParts Department[ ] Parts manager[ ] Parts clerk[ ] Parts inventory controlOffice[ ] Office manager[ ] Bookkeeper[ ] Cashier[ ] Secretary[ ] File clerk[ ] Data entry operatorYOUR REFERENCESCompleting this section of the application is optional. Leave this area blank if you do not wish to answer.List the names of any professional or personal character references who have known you for the last three years and from whom you can obtain letters of recommendation. Please do not list relatives:1. Name:__________________________________________________________________________________________________________Occupation:______________________________________________________________________________________________________Address:________________________________________________________________________________________________________City/State:______________________________________________________ Phone:___________________________________________Relationship to applicant:___________________________________________________________________________________________How long have you known this person?________________________________________________________________________________2. Name:________________________________________________________________________________________________________Occupation:______________________________________________________________________________________________________Address:________________________________________________________________________________________________________City/State:______________________________________________________ Phone:___________________________________________Relationship to applicant:___________________________________________________________________________________________How long have you known this person?________________________________________________________________________________3. Name_________________________________________________________________________________________________________Occupation:______________________________________________________________________________________________________Address:________________________________________________________________________________________________________City/State:______________________________________________________ Phone:___________________________________________Relationship to applicant:___________________________________________________________________________________________How long have you known this person?________________________________________________________________________________PLEASE READ THE FOLLOWING PARAGRAPHS CAREFULLY BEFORE SIGNING AND INITIALING AFTER EACH PARAGRAPH.By initialing each paragraph and signing below, I certify that I have read, understand and agree to each of the following statements:____ All of the information I have supplied on this application is true, accurate and complete, to the best of my knowledge, and I have not knowingly withheld any information which, if known to the Company, would affect my application unfavorably. If I am hired by the Company, and if the Company discovers at any time during my employment that any of the statements or answers on this application are false, misleading, or incomplete, I may be dismissed immediately from my job. ____ This employment application will be considered active for one hundred eighty (180) days from the date below. If I want to be reconsidered for a job with the Company after this period of time I must fill out another application. If hired, I understand that this application becomes part of my official employment record. ____ I understand that nothing in this employment application creates a contract of employment between me and the Company. If I am hired by the Company, my employment and compensation are "at will," which means that my employment can be terminated, either by the Company or me, with or without cause, and with or without notice. I understand that no manager or supervisor has the authority to make any employment agreement with me, either orally or in writing, that is not an at-will agreement. ____ I agree to release to the Company or its designated agents, all medical information, including by not limited to files, reports, xrays, evaluations, and opinions held by medical personnel, to the extent such information is job-related and consistent with the Company's business needs and agree to execute the necessary HIPAA-compliant release. I acknowledge that this is a general release and that if hired, it remains in effect for the duration of my employment. ____ I give the Company my permission to conduct any investigation regarding the information contained in my employment application, which the Company thinks is necessary to determine my qualifications for assuming a job with the Company. I give the Company my permission to contact any former employer, school, college or university, utility company, credit or finance bureau or office, any personal or professional reference, or any other appropriate source or individual (except for those specifically excluded in writing on this application) for the purpose of gathering any information, personal or otherwise, that such sources may have about my character, general reputation, health, credit, education or employment record, and I give my consent to any such source to release to the Company whatever information they have about me. I also unconditionally release all named and unnamed sources from any and all liability which might result from furnishing any information about me.DO NOT SIGN UNTIL YOU HAVE READ AND INITIALED THE ABOVE STATEMENTSApplicant’s Signature________________________________________________________________ Date__________________________Witness’ Signature __________________________________________________________________ Date_________________________AUTHORIZATION TO RELEASE INFORMATION AND RECORDSI,____________________________________________________ , have applied for a job with ( Company name ). I give my permission to ( Company name ) conduct any investigation regarding the information contained in my employment applications, which ( Company name ) thinks is necessary to determine my qualifications for assuming a job with the company. I give ( Company name ) my permission to contact any former employer, bureau or office, any personal or professional reference, or any other appropriate source or individual for the purpose of gathering any information, personal or otherwise, that such sources may have about my character, general reputation, credit, education, or employment record, and I give my consent to any such source to release to ( Company name ) whatever information they have about me. I also unconditionally release all named and unnamed sources from any and all liability which might result from furnishing any information about me.Applicant’s Signature_____________________________________________________ Date_____________Witness’ Signature _______________________________________________________ Date_____________EMPLOYMENT REFERENCEDates employed from ____________________ to ____________________.First Job Title:________________________________ Pay rate:________.Last Job Title:________________________________ Pay rate:________.Description of duties:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Eligible for rehire? [ ] Yes [ ] NoPlease rate the applicant in each of the following categories by using the descriptions below:Overall Ability to work[ ] Outstanding [ ] Above average [ ] Average [ ] Below averageQuality of work[ ] Outstanding [ ] Above average [ ] Average [ ] Below averageQuantity of work[ ] Outstanding [ ] Above average [ ] Average [ ] Below averageConduct on the job[ ] Outstanding [ ] Above average [ ] Average [ ] Below averageAttendance[ ] Outstanding [ ] Above average [ ] Average [ ] Below averageSignature __________________________________________________________________ Date___________ Title ______________________________________________________________________________________ ................
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