EMB Corporation

General Information

Full Name

Current Date

Address

City

Zip

Phone Number

How did you learn of this opening?

Are there any hours, shifts, or days you cannot or will not work?

Are you over 18 years old?

Yes No

Have you worked here before?

Yes No

Are you authorized to work in the U.S. on an unrestricted basis?

Yes No

If hired, would you consent to a physical and/or drug testing?

Yes No

Have you ever been convicted of a felony?

Yes No

If yes, please describe conditions:

(Conviction will not necessarily disqualify applicant for employment)

Education

High School Name

High School Diploma

College/University Name

Year Graduated

Major

Diploma/Degree

College/University Name

Year Graduated

Major

Diploma/Degree

Other Training/Education

In addition to work history, what other experiences, skills, or training might enhance your qualifications for employment with this company?

First position applied for

Second position applied for

When can you start?

Work History

Most Recent Employer

Employer Name

Address

Phone

Starting Date

Starting Salary

Starting Position

Ending Date

Ending Salary

Ending Position

Name and Title of Supervisor

May we Contact Employer?

Yes No

Description of Duties

Reason for Leaving

Previous Employer

Employer Name

Address

Phone

Starting Date

Starting Salary

Starting Position

Ending Date

Ending Salary

Ending Position

Name and Title of Supervisor

May we Contact Employer?

Yes No

Description of Duties

Reason for Leaving

Previous Employer

Employer Name

Address

Phone

Starting Date

Starting Salary

Starting Position

Ending Date

Ending Salary

Ending Position

Name and Title of Supervisor

May we Contact Employer?

Yes No

Description of Duties

Reason for Leaving

Previous Employer

Employer Name

Address

Phone

Starting Date

Starting Salary

Starting Position

Ending Date

Ending Salary

Ending Position

Name and Title of Supervisor

May we Contact Employer?

Yes No

Description of Duties

Reason for Leaving

Applicant's Certification and Agreement

I certify that the facts set forth in this Application for Employment are true and complete the the best of my knowledge. I understand that if I am employed, false statements may result in my dismissal. I authorize the Company to make an investigation of any of the facts set forth in this application.

I understand that employment at this Company is "at will" which means that either I or the Company can terminate the employment at any time, with or without prior notice, and for any reason not prohibited by statue. ALl employment is continued on that basis. I understand that no supervisor, manager, or executive of the Company, other than that of the President has any authority to alter the foregoing.

Date

Applicant's Signature

Employment Application

Employment Application

Most Recent Employer

Previous Employer

Previous Employer

Previous Employer