Application for Employment

Valid for 30 Days – Please answer all questions completely.

PERSONAL INFORMATION

Last Name

First Name

Date

Current Address

City

State/Province

Zip/Postal

Phone Number

Email

Have you ever been involuntarily terminated or requested to resign?

Yes

No

If “yes” explain:

If hired, can you provide verification of your legal right to work in the United States?

Yes

No

Have you ever worked under a different name?

Yes

No

If “yes” name:

If required for the position, do you have a valid driver’s license?

Yes

No

Would you be willing to travel for work?

Yes

No

Would you be willing to work overtime?

Yes

No

EMPLOYMENT INTERESTS

Position Desired

Date Available

Salary Desired

How were you referred to our company?

Employee ReferralEmployee Referral

OtherOther

SKILLS

(If applicable for position for which you are applying)

Skills (PC or other)

Do you have experience, training, qualifications or special skills which you think make you especially suited for work at this Company? (Explain)

NOTICE TO APPLICANTS:

This employer complies with the Americans with Disability Act of 1990. During the interview process, you may be asked questions concerning your ability to perform job-related functions. If you are given a conditional offer of employment, you may be required to complete a post-job offer medical history questionnaire and/or undergo medical examination. If required, all entering employees in the same job category will be subject to the same medical questionnaire and/or examination and all information be kept confidential and in separate files.

Employment History

(Start with current or most recent employer. Account for all time periods including unemployment, self-employment, and military service.)

Company Name *

Phone Number *

Address *

Address

City

State/Province

Zip/Postal

Your Position *

Immediate Supervisor *

Title *

Date Started *

Salary *

Date Left *

Salary *

Reason for Leaving: *

Job Duties *

May we contact this employer?

Yes

No

Company Name *

Phone Number *

Address *

Address

City

State/Province

Zip/Postal

Your Position *

Immediate Supervisor *

Title *

Date Started *

Salary *

Date Left *

Salary *

Reason for Leaving: *

Name

First

Last

Job Duties *

May we contact this employer?

Yes

No

References

List 3 Professional References. These should not be related to you and have known you at least one year.

Reference 1:

Name

Phone Number

Years Known

Relationship

Address

City

State/Province

Zip/Postal

Reference 2:

Name

Phone Number

Years Known

Relationship

Address

City

State/Province

Zip/Postal

Reference 3:

Name

Phone Number

Years Known

Relationship

Address

City

State/Province

Zip/Postal

Barber & Associates, Inc. is an Equal Employment Opportunity Employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, religion, national origin, disability, veteran status, citizenship status, or marital status. We assure you that your opportunity for employment with Barber & Associates, Inc. depends solely on your qualifications.

I have read these statements and answers to these inquiries.

Yes

No

Date

Signature

Type out your name as your digital signature.

PERSONAL INFORMATION

EMPLOYMENT INTERESTS

SKILLS

NOTICE TO APPLICANTS:

Employment History

References

Barber & Associates, Inc.

Jacksonville

Lakeland

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