Application For Employment

For a printable application to send by mail, click here.

Personal Information

Name:
First:    Middle:    Last:
Maiden Name:

Present Address:
City:
State:
Zip:
How long have you lived at your present address?
Telephone Number:
Email Address:
Emergency Contact Name:
Emergency Contact Phone Number:

Position Information

Position Applied For:
Desired Salary: No Preference
Days Available to Work:
Monday    Tuesday    Wednesday    Thursday    Friday    Saturday    Sunday   
How many hours can you work weekly?
Can you work nights?  
Employment Desired: Full Time Only     Part Time Only     Full or Part Time    
When are you available to start work?

Education

High School
Name of School:
Location (complete mailing address):
Number of Years Completed:
College
Name of School:
Location (complete mailing address):
Number of Years Completed:
Major & Degree:
Bus. or Trade School
Name of School:
Location (complete mailing address):
Number of Years Completed:
Major & Degree:
Professional School
Name of School:
Location (complete mailing address):
Number of Years Completed:
Major & Degree:

Other Information

Have you ever been convicted of a crime?  
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitiation:
Transportation Information
Do you have a driver's license?  
What is your means of transportation to work?
Driver's License Number:
State of Issue:
Special: Operator     Commercial (CDL)    Chauffeur
Expiration Date:
Have you had any accidents during the past three years?  
If yes, how many?
Have you had any moving violations during the past three years?  
If yes, how many?

References

Please list two references other than relatives or previous employers.

Reference 1

Name:
Position:
Company:
Address:
City, State ZIP:
Phone:

Reference 2

Name:
Position:
Company:
Address:
City, State ZIP:
Phone:

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying:

Military Experience

Have you ever been in the armed forces?  
Are you now a member of the national guard?  
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. If you need additional space, please e-mail employment@miserenity.com with additional information.

Employer 1

Name of employer:
Address:
City, State ZIP:
Phone:
Name of last supervisor:
Employment Start Date:
Employment End Date:
Starting pay or salary:
Final pay or salary:
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 company:

Employer 2

Name of employer:
Address:
City, State ZIP:
Phone:
Name of last supervisor:
Employment Start Date:
Employment End Date:
Starting pay or salary:
Final pay or salary:
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 company:

Employer 3

Name of employer:
Address:
City, State ZIP:
Phone:
Name of last supervisor:
Employment Start Date:
Employment End Date:
Starting pay or salary:
Final pay or salary:
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 company:

Employer 4

Name of employer:
Address:
City, State ZIP:
Phone:
Name of last supervisor:
Employment Start Date:
Employment End Date:
Starting pay or salary:
Final pay or salary:
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 company:
May we contact your present employer?  
Did you complete this application yourself?  
If not, who did?

By clicking Submit, you authorize the information provided in this Application for Employment is true, correct and complete. If employed, any misstatements or omissions of fact on this application may result in my dismissal.

I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.

If you decide to engage an investigative consumer reporting agency to report on my credit and personal history, I authorize you to do so. If a report is obtained you must provide, at my request, the name and address of the agency so I may obtain from them the nature and substance of the information contained in the report.