CIEN AGAVES
Online Application for Employment
We consider applicants for all positions without regard to race, color, religion, sex,
national origin, age, disability, veteran status or any other legally protected status.
Positions applied for:
Date:
How did you hear about this job?:
Newspaper
Employee
Walk-in
Relative
Other
APPLICATION INFORMATION
First Name:
Middle Name:
Last Name:
Phone Number:
E-Mail:
Street Address:
City, State, Zip:
If hired, do you have a reliable
means of trasportation to get to work?
Yes
No
Describe:
Are you legally eligible for employment in the U.S.?
Yes
No
(Proof of U.S. citizenship or immigration status is required if hired.)
Have you been convicted of a crime?
Yes
No
If yes, state the nature of the offense and disposition of the case.
Include dates and places.
(NOTE: The existence of a criminal record does not constitute an automatic bar to employment.)
Are you a veteran?
Yes
No
If yes, give dates of service:
EMPLOYMENT INFORMATION
Are you seeking full time, part time or temporary employment?
Full time
Part time
Temporary
What hours and shift(s) would you prefer to work?
List times you are not available to work.
Are you willing to work overtime?
Yes
No
If hired, when would you be able to start?
Have you ever worked for this organization before?
Yes
>
If yes, name used:
List any friends or relatives employed by this company:
Have you ever been discharged or asked to resign from any position?
Yes
No
If yes, please describe:
Are you able to perform all these tasks with or without reasonable
accommodation?
Yes
No
Please describe which tasks, if any, you will need accommodation
to perform, and explain what type of accommodation you will need:
EDUCATION (Tick highest level achieved)
Elementary:
1
2
3
4
5
6
7
8
Name of elementary School:
Location of elementary School:
Secondary:
9
10
11
12
G.E.D.
Name of secondary School:
Location of secondary School:
College:
1
2
3
4
5
6
7
8
Name of college:
Location of college:
Degree & Major:
Minor:
If in high school, are you enrolled in a recognized co-op program?
Yes
No
If yes, identify program and school:
Work History (please begin with most recent)
1.)
Company:
Phone No. with Area Code:
Address, City/State/Zip:
Dates of Employment From:
To:
Salary: Beginning
Ending:
Job title:
Supervisor’s Name & Title
Describe duties briefly:
Specific reason for leaving:
2.)
Company:
Phone No. with Area Code:
Address, City/State/Zip:
Dates of Employment From:
To:
Salary: Beginning
Ending:
Job title:
Supervisor’s Name & Title
Describe duties briefly:
Specific reason for leaving:
3.)
Company:
Phone No. with Area Code:
Address, City/State/Zip:
Dates of Employment From:
To:
Salary: Beginning
Ending:
Job title:
Supervisor’s Name & Title
Describe duties briefly:
Specific reason for leaving:
4.)
Company:
Phone No. with Area Code:
Address, City/State/Zip:
Dates of Employment From:
To:
Salary: Beginning
Ending:
Job title:
Supervisor’s Name & Title
Describe duties briefly:
Specific reason for leaving:
For references purposes: Have you worked for any of these organizations
or attended school under a different name?
Yes
No
If yes, give name and organization(s) :
May we contact the employers listed above?
Yes
No
If not, list the employers you do not wish us to contact and why:
Authorizations & At-Will Employment Agreement
(please read carefully, then submit form)
I certify that I have personally completed this application. I declare that the information provided in this
employment application is true and complete and I understand that any false information or significant omissions
may disqualify me from further consideration for employment and may be justification form my dismissal from
employment if discovered at a later date. I agree to immediately notify this company if I should be convicted of
a crime while my job application is pending or during my employment, if hired.
I authorize this company to make an investigation of all information contained in this employment application
and I release from liability all companies and corporations supplying such information. I understand any false
answers, statements, or implications made by me on this application or other required documents shall be
considered sufficient cause for denial of employment or discharge.
I specifically authorize and direct my current and former employers to supply employment-related information
to this company and do hereby release my current and former employers from liability for providing information
to this company.
Upon termination of my employment for whatever reason, I release this company from all liability for supplying
any information concerning my employment to any potential employer.
I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record,
and any other investigative report deemed necessary through various third party sources. As required by law,
upon request within a reasonable period of time, I will be notified as to the nature and scope of such
investigations.
AT-WILL EMPLOYMENT AGREEMENT
I understand and agree that nothing contained in this application, or conveyed during any interview is intended
to create an employment contract between the company and me. In addition, I understand and agree that if you employ me,
in consideration of my employment, my employment and compensation will be at-will, for no definite period of time,
and may be terminated at any time, for any reason, or for no reason at all. I understand that only the company’s
President is authorized to change the employment-at-will status and such a change can only be done in writing.
I have read, understand, and agree to the above.
BY SUBMITING THIS FORM YOU AGREE TO "Authorizations & At-Will Employment Agreement"
THANK YOU.
-Cien Agaves.com