Sample Employment Application Form

	

		

	

	

	

	

	

					

					

					

	

	

	

	

		

	

	

		

		

	

	

	

	

	

			

	

		

		

	

	

	

				

	

	

	

			

		

	

	

	

	

	

	

	

	

	

PLEASE READ CAREFULLY	

APPLICATION FORM WAIVER
	
In exchange for the consideration of my job application by ___________________ (hereinafter called “the Company”), I agree that:
Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of                         , or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company.  Both the undersigned and                         may end the employment relationship at any time, without specified notice or reason.  If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.	
I authorize investigation of all statements contained in this application.  I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice.  I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contact.	
I also understand that (1) the Company has a drug and alcohol policy that provides for preemployment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy.  I further understand that continued employment may be based on the successful passing of job-related physical examinations.	
I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living.  Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.	
I further understand that my employment with the Company shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.	

Signature of applicant__________________________________________ Date: ___________________ 

This Company is an equal employment opportunity employer.  We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability.  We assure you that your opportunity for employment with this Company depends solely on your qualifications.
	
	Thank you for completing this application form and for your interest in our business.

	

	

	

	

	

				

				

			

	

	

Applicant Selection Criteria Record

JOB TITLE
	
CANDIDATES CONSIDERED (INCLUDING MINORITIES AND FEMALES)
	
NAME	MALE/
FEMALE	ETHNIC
CODE*	ON LAB SECTION/ OFF LAB	

			

	

			

	

     *ETHNIC CODES:  1-BLACK, 2-ORIENTAL, 3-HISPANIC, 4-AMERICAN INDIAN, 0-OTHER	
CANDIDATE SELECTED
	
NAME	MALE/
FEMALE	ETHNIC
CODE	SOURCE	

SELECTION CRITERIA

	

	

	

REASONS CANDIDATE SELECTED WAS PREFERABLE TO OTHERS

	

	

	
	ORIGINATOR'S SIGNATURE	DATE