Employment Application * denotes required fields Date Your Name* Your Email* Address City, ST ZIP Home Phone Additional Phone Best Time to Contact You Position Applying For Are you a U.S. citizen or legally eligible to hold employment in the U.S.? YesNo Are you at least 18 years old? YesNo Do you have a valid New York state driver's license? YesNo Have you been convicted of a felony within the last 7 years? YesNo Conviction will not necessarily disqualify an applicant from employment. List Other Skills ConstructionComputersElectricalClericalSalesManagementWarehouse/ProductionOther (enter below) Employment History May We Contact Your Present Employer? YesNo NOTE: We will have to contact your present employer before offer to hire will be made. Information provided is subject to verification. Current / Previous Employer(s): Employer 1 Company Name: Position/Title: Address: City, St ZIP: Employment Dates: ( start / end ) Supervisor: Supervisor Title: Phone Number: Rate of Pay: Employer 2 Company Name: Position/Title: Address: City, St ZIP: Employment Dates: ( start / end ) Supervisor: Supervisor Title: Phone Number: Rate of Pay: Employer 3 Company Name: Position/Title: Address: City, St ZIP: Employment Dates: ( start / end ) Supervisor: Supervisor Title: Phone Number: Rate of Pay: Applicant's Statement: By submitting this form, I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. We consider all applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. Enter captcha code below.