Employment Application

Note: Applications for Employment are valid for 60 days from the date of above signature.

Full Name *

First

Middle

Last

Address *

City *

State *

Zip *

Phone *

Email *

Date Available *

Social Security Number *

Desired Salary *

Position Applied for *

Are you willing and able to work full-time? *

Are you willing and able to work part-time? *

Are you a citizen of the United States? *

If no, are you authorized to work in the U.S.? *

Are you over the age of 18 *

If no, you may be required to provide work authorization.

Have you ever worked for this company? *

If no, you may be required to provide work authorization.

If yes, when? If no, say N/A. *

Do you have friends/relatives who work for company? *

If yes, who? If no, say N/A. *

Have you ever done any volunteer work? *

If yes, describe. If no, say N/A. *

High School Attended *

Location *

Years Attended High School *

Did you graduate high school? *

Diploma? *

College Attended *

Location *

Years Attended College *

Did you graduate college? *

Degree? *

Have you completed any special courses, seminars, and/or training directly related to the position for which you are applying? *

If yes, describe. If no, say N/A. *

Do you belong to any professional, trade, business, or civic organizations that deal with the position for which you are applying? *

If yes, describe. If no, say N/A. *

Reference #1 *

Please list your first professional and/or personal reference. You must include: Full Name, Relationship, Company, Phone and Address.

Reference #2 *

Please list your second professional and/or personal reference. You must include: Full Name, Relationship, Company, Phone and Address.

Reference #3 *

Please list your third professional and/or personal reference. You must include: Full Name, Relationship, Company, Phone and Address.

Previous Employment (Company Name) *

Address *

Phone *

Supervisor *

Dates of Employment *

Reason for Leaving *

Job Title *

Responsibilities *

May we contact your previous supervisor for a reference? *

Have you ever been convicted of a crime or arrested for a felony? *

If yes, please explain. If no, say N/A. *

Have you ever worked for a company that required random drug testing? *

If yes, please explain. If no, say N/A. *

Have you ever refused to take a random drug test, or had a positive result on a drug test? *

If yes, please explain. If no, say N/A. *

Applicant Certification and Agreement *

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge, and I authorize MCOP to verify their accuracy and to obtain reference information on my work performance. I hereby release MCOP from any and all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information. I understand that, if offered employment, falsified statements or omissions of any kind called for on this application shall be considered sufficient basis for dismissal. Should I be extended an offer of employment, I agree to fully adhere to policies, rules, and regulations of employment as defined by the Employer should I accept the offered position. I further understand that neither the policies, rules, and regulations of employment, nor anything said during the interview process shall be deemed to constitute terms of an implied contract. I understand that any employment offered is at will for an indefinite duration, and that either the Employer or myself may terminate my employment at any time with or without notice or cause.

Signature *

Please type your full legal name