Application for Employment

 


Contact Information

NAME -

Last     First     Middle


CURRENT ADDRESS -

Street Apt

City State Zipcode


PERMANENT ADDRESS -

Street Apt

City State Zipcode


PHONE NUMBERS -

Home # Cell #


DRIVER'S LICENSE INFO -

License # State


SOCIAL SECURITY #


EMAIL ADDRESS -


EMERGENCY CONTACT - List someone we can contact in case of an emergency.

Name Address Phone #


 


Employment Details

Are you legally able to be employed in the United States? (proof may be required) YES NO

Position Desired Full Time Part Time Shift Work Temporary


Desired Salary Range Date you can start

What is your preferred work schedule?


Have you applied at FMS before? YES NO
If yes, give the date you applied.


Have you been employed at FMS before? YES NO
If yes, give the dates of your employment.


If requested, are you willing to work overtime? YES NO


How were you referred to us?


 


Education
  School Name and LocationYears CompletedYear GraduatedName of Degree or Deploma
high school
college
trade or
business school
other

List any other honors,
awards, certificates,
or training you have received.
List any information that
may help us consider your
application.


 


Personal References - List 3 references not related to you.

  Name Address Phone # Business Years Aquainted
1
2
3


 


Employment Experience

Dates Employed

Starting Salary

Ending Salary
Employer

Address

Phone
Supervisor


May we contact?
YES NO
Position and Work Performed
Reason(s) for Leaving


Dates Employed

Starting Salary

Ending Salary
Employer

Address

Phone
Supervisor


May we contact?
YES NO
Position and Work Performed
Reason(s) for Leaving


Dates Employed

Starting Salary

Ending Salary
Employer

Address

Phone
Supervisor


May we contact?
YES NO
Position and Work Performed
Reason(s) for Leaving


Dates Employed

Starting Salary

Ending Salary
Employer

Address

Phone
Supervisor


May we contact?
YES NO
Position and Work Performed
Reason(s) for Leaving


 


Have You Been Convicted of a Felony or Misdemeanor? YES NO

If yes, please describe.



 


"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified
statements on this application or interview may be grounds for dismissal."

"I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous
employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability from any damage that may
result from furnishing same to you."

"I understand and agree that, if hired, my employment will be 'at will', without any definite period of time, and may be terminated at anytime, with or
without cause and with or without prior notice, regardless of the date of payment of my wages or salary."

"I understand that as a condition of employment, I may be required to undergo a medical examination and substance test at the company's expense."