Job Application Form
Last Name:			First Name:
Middle Name:			Maiden Name:
Present Address:				State: Zip:
How Long at this Address:		Social Security Number:	- -
Telephone:		E-Mail:
Fax (if available):		If under 18, please list age:
Position Applied For:			And Salary Desired:
Days/Hours Available to work:		No Pref Thursday Monday Friday Tuesday Saturday Wednesday Sunday
Employment Desired:	FULL TIME ONLY      PART TIME ONLY      FULL TIME or PART TIME
Date available for work:
Education
School:		Location (City, State):		# Years Completed:	Major & Degree:
High School:
College:
Bus./Trade School:
Professional School:
Have you ever been convicted of a crime?:		YES       NO
If yes, please state offenses and dates:
Authorization
Are you authorized to work in the United States? :		YES       NO
Military
Have you ever been in the US Armed Forces? :		YES       NO Specialty Date entered Discharge Date
Work Experience:
Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name.
Name of Employer: Name of last supervisor:		Employment Dates: Pay or Salary:		/ Start: Final:
Employers Address:				State: Zip:
Employers Telephone:		Your last job title:
Reason for leaving (be specific):
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this job:
Name of Employer: Name of last supervisor:		Employment Dates: Pay or Salary:		/ Start: Final:
Employers Address:				State: Zip:
Employers Telephone:		Your last job title:
Reason for leaving (be specific):
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this job:
Name of Employer: Name of last supervisor:		Employment Dates: Pay or Salary:		/ Start: Final:
Employers Address:				State: Zip:
Employers Telephone:		Your last job title:
Reason for leaving (be specific):
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this job:
Name of Employer: Name of last supervisor:		Employment Dates: Pay or Salary:		/ Start: Final:
Employers Address:				State: Zip:
Employers Telephone:		Your last job title:
Reason for leaving (be specific:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this job:
May we contact your present employer:		YES       NO
May we contact past employers? :		YES       NO
Did you complete this application yourself:		YES       NO
If No, who did and why:
Do you have transportation to work:		YES       NO
Office - Computer
Typing:		YES       NO        WPM
Word Processing:		YES       NO        WPM
Other:
Personal Computer:		YES       NO      if yes, PC       MAC
Skills:
List programs used:
References:
Please list two references other than Relatives or Previous Employers:
Name & Position:		Company:	Address:		Telephone:
An Application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the text area below to include any additional information necessary to describe your full qualifications for the specific position for which you are applying.
Please read carefully
APPLICATION FORM WAIVER In exchange for the consideration of my job application by KEGEL (hereinafter called "the Company") I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, ant the like as they may exists from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of the Company, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that the relationship cannot be altered except by a written instrument signed by the President/General Manager of the Company. Both the undersigned ant the Company may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the company may unilaterally change or revise their benefits, policies and procedures and such changes may include redaction of benefits. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references and others, and hereby release the Company from any liability as a result of such. I also understand tar (1) the Company has a drug and alcohol policy that may provide for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is condition of my employment; and (3) continued employment may be based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations. I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit reports, character, general reputation, personal characteristics, and mode of living. Upon written request from me the Company will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. I further understand that my employment with the Company shall be probationary for a period of ninety (90) days, and further that anytime during the probationary period or thereafter, my employment relation with the company is terminable at will for any reason by either party. This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications. Thank you for completing this application form and for your interest in our business.