Employment Application

Alvord-Polk is committed to excellence, both now and in the years to come. Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, handicap or veteran status.

Personal Data
Referral Source:
Advertisement
Employee
Relative
Walk-in
Other
First Name:
Middle Name:
Last Name:
Address 1:
Address 2:
City:
State:
ZIP:
Email:
Home phone
with area code:

Best time to call:

May we call you at work?  Yes   No
   If yes, work phone with area code:

Are you 18 years or older? Yes   No
Date eligible for work (MM/DD/YYYY):

Employment desired:
Position applying for:

Do you have any special qualifications?

Educational History
Grammar School
Name:
Location:
Years completed:
High School
Name:
Location of school:
Course of study:
Years completed:
Degree/diploma:
College
Name:
Location of school:
Course of study:
Years completed:
Degree/diploma:
Other
Name:
Location of school:
Course of study:
Years completed:
Degree/diploma:

Membership in professional or civic organizations: (exclude those which may disclose your race, color, religion or national origin)

Employment History
Please give accurate, complete full-time and part-time employment record. Start with present or most recent employer.
Military Service
From:    To:
Branch of service:
Rank:
Duties:

Places of Employment
Company Name:
Employed from:   To:
Address:
City:
State: ZIP:
Title:
Duties:
Reason for leaving:
   
Company Name:
Employed from:   To:
Address:
City:
State: ZIP:
Title:
Duties:
Reason for leaving:
   
Company Name:
Employed from:   To:
Address:
City:
State: ZIP:
Title:
Duties:
Reason for leaving:
    
Company Name:
Employed from:   To:
Address:
City:
State: ZIP:
Title:
Duties:
Reason for leaving:

 

References
Name:
Occupation:
Address:
City:
State: ZIP:
Phone with Area Code:
   
Name:
Occupation:
Address:
City:
State: ZIP:
Phone with Area Code:
   
Name:
Occupation:
Address:
City:
State: ZIP:
Phone with Area Code:

The information provided in this Application for Employment is true, correct and complete. If employed, any misstatement or emission of fact on this application may result in my dismissal. In consideration of my employment, I agree to conform to the rules and regulations of the Company and my employment and compensation can be terminated, with or without cause, at any time, at the option of the Company or myself. If required by the Company, I agree to undergo a pre-employment physical (including drug testing).

Name:
Date: