Name:
Location
you prefer:
Boca Raton
Boynton Beach Elite
Coral Springs
Delray Beach
Greenacres
Lantana
Palm Beach Gardens
Royal Palm Beach
West Palm Beach
Are you
18 yrs or older?:
Yes
No
Home Phone:
E-mail:
Full
Time / Part Time:
Full Time
Part Time
If Part
Time, Total Hours Available Per Week:
Address:
City:
State:
Zip:
Do
you have reliable transportation?:Yes
No
High
School / Grad. Date:
/
Secondary
Schools (College, Graduate,Technical, etc)
School
1 / Grad. Date:
/
School
2 / Grad. Date:
/
School
3 / Grad. Date:
/
Please list three (3) most recent jobs.
(if not applicable, list U.S. Military or work performed on
a volunteer basis) Please explain any gaps in employment history.
Company:
Address:
City:
State:
Zip:
Job
Title:
Supervisor:
Phone:
May
We Contact?:
Yes
No
Dates
Employed:
to
Start
Pay / End Pay:
/
Times
Absent:
/ Year
Reason
for Leaving:
Company:
Address:
City:
State:
Zip:
Job
Title:
Supervisor:
Phone:
May
We Contact?:
Yes
No
Dates
Employed:
to
Start
Pay / End Pay:
/
Times
Absent:
/ Year
Reason
for Leaving:
Company:
Address:
City:
State:
Zip:
Job
Title:
Supervisor:
Phone:
May
We Contact?:
Yes:
No:
Dates
Employed:
to
Start
Pay / End Pay:
/
Times
Absent:
/ Year
Reason
for Leaving:
Please Tell Us About Your History:
Have
you ever been employed by
If
yes: Where / When:
/
What
prompted you to apply at
In
Case Of Emergency Notify:
Address:
Phone:
Have
you ever been disciplined for absenteeism or tardiness by a
previous employer?:
Yes:
No:
If
YES, explain:
During
the past 10 years, have you been convicted of a crime, misdemeanor/felony
including under the influence of intoxicants?:
Yes:
No:
If
YES, give date, nature of offense(s) and where convicted*:
Date:
Nature
of Offense(s):
City:
State:
Please ReaBelow Before Submitting
Application
We consider applicants for all positions without regard
to race, color, religion, creed, sex, national origin or
any other consideration made unlawful by federal, state
or local laws. 1. I declare that all statements and answers in this application
are true and complete. I also agree that if employed,
any untruth, misleading answer, omission, concealment or
failure to answer any question fully, completely and accurately
will be grounds for terminating my employment. 2.
I authorize or agent to investigate
my references, to communicate with my former employers concerning
same, make an independent investigation of my character/conduct/employment
record and to keep and preserve records of such investigations.
In compliance with the Fair Credit and Reporting Act (15
U.S.C.S. Section 1681). I am advised that a routine investigative
consumer report may be conducted relative to my character,
general reputation, personal characteristics and credit
history. You have the right to request the source,
information, nature and scope of the investigation, if one
is conducted. 3. If employed, I agree that upon
termination of my employment I will return all company property
and records in my possession. 4. If employed,
I agree to read and comply with Company rules, regulations
and policies. 5. It is mutually understood and
agreed that any employment I accept is not confined to a
fixed term and may be ended by either party at-will, with
or without cause or prior notice. No representatives
of has authority to make any contrary agreement.
6. I understand that Federal Law prohibits the employment
of illegal aliens. All persons hired must submit satisfactory
proof of employment authorization. Failure to submit
same within the required time shall result in immediate
employment termination. 7. I hereby give permission
to to periodically tape record my voice on phone
calls made to this office for educational purposes.
