Employment Application Form

Printable Application
All Information is required

Employee Information








Are you able to perform the essential function of the position with or without accommodations?
Yes No

Are you legally eligible for employment in the U.S.?
Yes No

Are you seeking a permanent position?
Yes No

How long will you be able to work after you're notified to be hired

If necessary for the job, are you able to work overtime?
Yes No

If necessary for the job, provide a valid New Mexico Driver's License?
Yes No

If able to provide a valid New Mexico Driver's License, fill out the license info.
Number:

Class:
D E
Other Class:

Days available to work:
I have no preference Monday Tuesday Wednesday Thursday Friday Saturday Sunday

What type of hours do you prefer to work in?
Any Full-time Part-time

How many hours can you work weekly?

Can you work nights?
Yes No

When can you start?

Have you ever been employed by this organization in the past? Yes No

Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgment to a felony? If yes, please explain:

How many accidents in the past three years?

How many driving violations in the past three years?

All Information is required

Employment History

Employment 1

Employer

Start Date:
End Date:

Pay-rate:

Position title/duties, skills:

Supervisor:
Telephone:

Reason For Leaving:

Employment 2

Employer

Start Date:
End Date:

Pay-rate:

Position title/duties, skills:

Supervisor:
Telephone:

Reason For Leaving:

Employment 3

Employer

Start Date:
End Date:

Pay-rate:

Position title/duties, skills:

Supervisor:
Telephone:

Reason For Leaving:

All Information is required

Education

High School

name:

Graduated:

College/University

name:

Years Completed:

Field of Study:

Graduate or Degree:

Business/Technical

name:

Years Completed:

Field of Study:

Graduate or Degree:

Additional Education

name:

Years Completed:

Field of Study:

Graduate or Degree:

Military

Are you a Veteran? If so, what was your duty or specialized training?

All Information is required

References

List two personal references who are not relatives or former supervisors.

Name
Address
Phone Number
Occupation
Years Known

Name
Address
Phone Number
Occupation
Years Known

Name
Address
Phone Number
Occupation
Years Known

Name
Address
Phone Number
Occupation
Years Known

Information to the Applicant

I certify that all answers and statements on this application are true and complete to the best of my knowledge. I understand that, should this application contain any false or misleading information, my application may be rejected or my employment with this company terminated.

Thank you, we will be in contact with you soon.