Apply Online – Granger, Indiana – MAP of Easton, Inc.

EMPLOYMENT APPLICATION
MAP Location: Granger, Indiana

First Name

Last Name

Social Security Number

Phone

Email Address

Current Address

Street

Apt/Suite/Etc.

City

State

ZIP

Country

Previous Address

Street

Apt/Suite/Etc.

City

State

ZIP

Country

Are you under 18 years of age?

If yes, can you furnish a work permit?

Are you eligible to work in the United States?

Have you ever worked here before?

If yes, give date(s) and position.

Have you ever been convicted of a crime?

If yes, please provide date(s) and details.

WORK PREFERENCES

What position(s) are you applying for?

What type of employment do you want?

Minimum acceptable salary?

When are you available for employment?

What days and hours can you work?

Do you have reliable transportation to and from work?

Are you willing to travel, if required?

If yes, what percent of the time?

Will you work overtime, if required?

If no, please explain.

Are you related to any employee?

EMPLOYMENT HISTORY

Employer #1

Employment Dates

Employer

Job Title

Immediate Supervisor and Title

May we contact for reference?

Employer Phone

Employer Address

Street

Apt/Suite/Etc.

City

State

ZIP

Country

Summarize the nature of work performed and job responsibilities.

Reason for leaving?

Beginning rate/salary?

Final rate/salary?

Employer #2

Employment Dates

Employer

Job Title

Immediate Supervisor and Title

May we contact for reference?

Employer Phone

Employer Address

Street

Apt/Suite/Etc.

City

State

ZIP

Country

Summarize the nature of work performed and job responsibilities.

Reason for leaving?

Beginning rate/salary?

Final rate/salary?

Employer #3

Employment Dates

Employer

Job Title

Immediate Supervisor and Title

May we contact for reference?

Employer Phone

Employer Address

Street

Apt/Suite/Etc.

City

State

ZIP

Country

Summarize the nature of work performed and job responsibilities.

Reason for leaving?

Beginning rate/salary?

Final rate/salary?

Have you held additional jobs prior to these?

Time unemployed since leaving school?

EDUCATIONAL BACKGROUND

High School

Did you graduate High School?

College(s)

Did you graduate College?

Trade School/Other

Did you graduate Trade School/Other?

ADDITIONAL INFORMATION

Computer Skills

Licenses, certifications and registrations related to the work for which you are applying.

REFERENCES

Reference #1

Name

Phone (Home)

Phone (Work)

Employer and Position Held

Relationship

Years Known

Reference #2

Name

Phone (Home)

Phone (Work)

Employer and Position Held

Relationship

Years Known

Reference #3

Name

Phone (Home)

Phone (Work)

Employer and Position Held

Relationship

Years Known

APPLICANT STATEMENT I certify that the information contained in this application is correct to the best of my knowledge. I understand that falsification, or omission of facts is grounds for refusal to hire me, or discharge should I be hired. I authorize MAP of Easton, Inc. (the company) to obtain information from any person or organization named above and I release all concerned parties from any liability in connection with obtaining and releasing such information. In consideration for my employment, I agree to conform to the rules and regulations of the company, I acknowledge that these rules and regulations may be changed at any time without prior notice to me. I also understand that my employment may be terminated or any offer or acceptance of employment withdrawn at any time with or without cause and with or without prior notice at the option of the company or myself. I understand that no representative of the company has any authority to enter into any agreement for employment or to promise any other personnel action either before or after I accept employment or to guarantee any benefits or terms or conditions of employment or to make any other agreement which is contrary to this agreement.

APPLICANT STATEMENT

I certify that I have read, fully understand, and accept all terms of the foregoing applicant statement.

Date