General Application

Personal Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Main Phone Number
Alternate Phone Number
Email
Employment Experience
Please list the names of your present or previous employers in chronological order with present or most recent employer listed first. Be sure to account for all periods of time. If self-employed, give firm name and supply business references.
Employer's Name
Supervisor
May we contact?
- Yes
- No
Employer's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Employed
Job Title and Duties
Reason for Leaving
Employer's Name
Supervisor
May we contact?
- Yes
- No
Employer's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Employed
Job Title and Duties
Reason for Leaving
Employer's Name
Supervisor
May we contact?
- Yes
- No
Employer's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Employed
Job Title and Duties
Reason for Leaving
Have you hever been involuntarily terminated or asked to resign from any job?
- Yes
- No
If yes, please explain
Please explain any gaps in your employment history
Please list any other experience, job related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualifications for employment.
Education
High School
School Name Years Completed Diploma/Degree (Yes/No) Area of Study/Major Specialized Training, Skills, or Extra Curricular Activities
College/University
School Name Years Completed Diploma/Degree (Yes/No) Area of Study/Major Specialized Training, Skills, or Extra Curricular Activities
Graduate/Professional School
School Name Years Completed Diploma/Degree (Yes/No) Area of Study/Major Specialized Training, Skills, or Extra Curricular Activities
Trade School
School Name Years Completed Diploma/Degree (Yes/No) Area of Study/Major Specialized Training, Skills, or Extra Curricular Activities
Other (Specify)
School Name Years Completed Diploma/Degree (Yes/No) Area of Study/Major Specialized Training, Skills, or Extra Curricular Activities
Business and Professional References
Please list three professional references of individuals who are not related to you*
Name and Title Relationship Phone Number or Email
Personal References
Please list three professional references of individuals who are not related to you*
Name and Title Relationship and Years Acquainted Phone Number or Email
General Information
Have you ever used another name?
- Yes
- No
Is any additional information relative to name changes, use of an assumed name, or nickname necessary to enable a check on your work and educational record?
- Yes
- No
Please explain
Have you ever worked for this company before?
- Yes
- No
Please give dates and position
Do you have friends and/or relatives working for this company?
- Yes
- No
Please give name(s) and relationship(s)
On what date are you available to begin work?
Days/Hours available to work?
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Are you available to work?
- Full-Time
- Part-Time
- Shift Work
- Temporary
Minimum salary required?
Per Hour Per Month
If hired, would you have a reliable means of transportation to and from work?
- Yes
- No
Can you travel if the position requires it?
- Yes
- No
Can you relocate if the position requires it?
- Yes
- No
Are you at least 18 years old?
Note: If under 18, hire is subject to verification that you are of minimum legal age.
- Yes
- No
If hired, can you present evidence of your identity and legal right to work in this country?
- Yes
- No
Are you able to perform the essential job functions of the job for which you are applying with or without reasonable accomodation?
- Yes
- No
Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions.
*
I hereby authorize the Company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out fo or in any way related to such investigation or disclosure.
*
In the event of my employment with the Company, I understand that I am required to simply with all rules and regulations of the Company.
*
If hired, I understand and agree that my employment with the Company is at will, and that neither I, nor the Company is required to continue the employment relationship for any specific term. I further understand that the Company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.
*
I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned application, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document user to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
*
I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my 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.
*
I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable.
Comments
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Serving Hampton Roads Since 1964

General Application

Personal Information

Employment Experience

Education

Business and Professional References

Personal References

General Information

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School Name	Years Completed	Diploma/Degree (Yes/No)	Area of Study/Major	Specialized Training, Skills, or Extra Curricular Activities

School Name	Years Completed	Diploma/Degree (Yes/No)	Area of Study/Major	Specialized Training, Skills, or Extra Curricular Activities

School Name	Years Completed	Diploma/Degree (Yes/No)	Area of Study/Major	Specialized Training, Skills, or Extra Curricular Activities

School Name	Years Completed	Diploma/Degree (Yes/No)	Area of Study/Major	Specialized Training, Skills, or Extra Curricular Activities