Application For Employment



Application active for 60 days from date of application
 
In order that your application may be properly evaluated, it is essential that you answer all questions on this application truthfully and completely.
 
You will be considered for employment without regard to your race, color, creed, sex, religion, marital status, national origin, status without regard to public assistance, disability or age.


 
PERSONAL INFORMATION
     
First Name Middle Last Name
     
Present Address    
Street
     
City State Zip Code
     
Phone Number How long at present address?
( ) -  years  months  
     
Permanent Address ( same as above )
Street
     
City State Zip Code



EMPLOYMENT DESIRED
     
Position Desired Salary Desired  
per
     
Will you accept any of the following (Select all that apply)
 
     
Are you employed now/where?  
 
     
May we contact your present employer?  
Yes  No    
     
How did you learn of this opening?  
   
     
Are you acquainted with or related to any person employed here?  
Yes  No If so, who and relationship? 
   
Can you work overtime?  
Yes  No  



EDUCATION
       
High School
Name Address    
 
       
Dates Attended (mm/dd/yy) Diploma / Degree Did you graduate?  
to  
       
College      
Name Address    
 
       
Dates Attended (mm/dd/yy) Diploma / Degree Did you graduate?  
to Yes  No  
       
       
Vocational/Business
Name Address    
 
       
Dates Attended (mm/dd/yy) Diploma/Degree Did you graduate?  
to Yes  No  
       
Military Experience (Describe)    
       
Secretarial, Clerical, and Office Applicants Only  
Can you type?      
Yes  No Speed (wpm)     
       
Take dictation?      
Yes  No Speed (wpm)   
       
Can you use a calculator?    
Yes  No      
       
Do you know medical terminology?    
Yes  No      
       
What are you computer skills?    
 



EMPLOYMENT HISTORY  
     
  Note: List last or present position first  
     
1. Company Name  
   
     
  Street Address  
   
     
  City State Zip Code  
   
     
  Supervisor Phone Number  
  - -  
     
  Dates of Employment (mm/dd/yy) Salary  
   to  per  
     
  Position and Duties  
   
     
  Reason For Leaving  
   
     
2. Company Name  
   
     
  Street Address  
   
     
  City State Zip Code  
   
     
  Supervisor Phone Number  
  - -  
     
  Dates of Employment (mm/dd/yy) Salary  
   to  per  
     
  Position and Duties  
   
     
  Reason for Leaving  
 
     
3. Company Name  
   
     
  Street Address  
   
     
  City State Zip Code  
   
     
  Supervisor Phone Number  
  - -  
     
  Dates of Employment (mm/dd/yy) Salary  
   to  per  
     
  Position and Duties  
   
     
  Reason for Leaving  
 
     
If your former employment references are under a name other than indicated on application please list



GENERAL
     
Are you eligible to work in the United States?  
Yes  No If not a U.S. Citizen, identify you status
     
Have you been charged with committing any felonies within the last 7 years?
Yes  No    
     
If your answer is yes, please explain the charges, where the charges were filed, and the disposition or status of the charges.



READ CAREFULLY BEFORE SIGNING
     
1. All facts contained in this application true and complete to the best of my knowledge and I understand that, if employed, and false statement on this application will grounds for dismissal.
     
2. I authorize Better Brands, Inc. to investigate all facts contained in this application and any references I provided and all information concerning my previous employment positions and any pertinent information that Better Brands, Inc. may have, personal or otherwise, and I release all parties from any and all liability for any damages that may result from any person furnishing information to Better Brands, Inc. I understand that this Consent authorizes my former employers to respond fully to questions asked by Better Brands, Inc. regarding my previous employment.
     
3. I understand that if employed, my employment is at will, and that either party is free to terminate the employment relationship at any time without cause and without notice.
     
Signature Date  
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