Employment Application LinkedInThis field is for validation purposes and should be left unchanged.Name First Last Date MM slash DD slash YYYY Present Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Permanent Address (if different from present address) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Position applying forAre you applying for: Regular full-time work? Regular part-time work? Temporary work, e.g., summer or holiday work? Other than time off for reasons related to your religion, a disability or a medical condition, are there any days or times when you are unavailable to work?If applying for temporary work, during what period of time will you be available? Enter start and enda dateWould you be available to work overtime, if necessary? Yes No If hired, what date can you start work? Personal InformationHow did you hear about our company and this job opening?Have you ever applied to or worked for us? Yes No Why are you applying for work at K-Tech Machine?If yes, when?If hired, would you have a reliable means of transportation to and from work? Yes No Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.) Yes No Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? Yes No If no, describe the functions that cannot be performed.(Note: We comply with the Fair Employment and Housing Act (FEHA) and the Americans with Disabilities Act (ADA). We consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. New hires may be subject to passing a medical examination, and to skill and agility tests.) We may refuse to hire relatives of present employees if doing so could result in actual or potential problems in supervision, security, safety or morale, or if doing so could create conflicts of interest.Education, Training, and ExperienceHigh School Name School Name Number of Years CompletedDid you graduate? Yes No Degree or DiplomaAddress Street Address City State / Province / Region ZIP / Postal Code Collage Name School Name Number of Years CompletedDid you graduate? Yes No Degree or DiplomaAddress Street Address City State / Province / Region ZIP / Postal Code Vocational/ Business School Name Number of Years CompletedDid you graduate? Yes No Degree or DiplomaAddress Street Address City State / Province / Region ZIP / Postal Code Health Care Training School Name Number of Years CompletedDid you graduate? Yes No Degree or DiplomaAddress Street Address City State / Province / Region ZIP / Postal Code Do you have any other experience, training, qualifications, or skills that you feel make you especially suited for work at Yes No If so, please explain:Answer the following questions if you are applying for a professional position:Are you licensed/certified for the job applied for? Yes No Name of license/certification:Issuing StateLicense/certification number:Has your license/certification ever been revoked or suspended? If yes, state reason(s), date of revocation or suspension, and date of reinstatement.Employment History List below all present and past employment starting with your most recent employer (last five years is sufficient). You must complete this section even if attaching a resume.Name of Employer First PhoneType of BusinessYour Supervisor's NameAddress Street Address City State / Province / Region ZIP / Postal Code Dates of Employment: Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Your Position and DutiesReason for LeavingCurrent employer? Yes No May we contact this employer for a reference? Yes No Name of Employer First PhoneType of BusinessYour Supervisor's NameAddress Street Address City State / Province / Region ZIP / Postal Code Dates of Employment: Start Date MM slash DD slash YYYY Your Position and DutiesEnd Date MM slash DD slash YYYY Reason for LeavingMay we contact this employer for a reference? Yes No Current employer? Yes No Name of Employer First PhoneType of BusinessYour Supervisor's NameAddress Street Address City State / Province / Region ZIP / Postal Code Dates of Employment: Start Date MM slash DD slash YYYY Your Position and DutiesEnd Date MM slash DD slash YYYY Reason for LeavingMay we contact this employer for a reference? Yes No Current employer? Yes No Name of Employer First PhoneType of BusinessYour Supervisor's NameAddress Street Address City State / Province / Region ZIP / Postal Code Dates of Employment: Start Date MM slash DD slash YYYY Your Position and DutiesEnd Date MM slash DD slash YYYY Reason for LeavingMay we contact this employer for a reference? Yes No Current employer? Yes No Name of Employer First PhoneType of BusinessYour Supervisor's NameAddress Street Address City State / Province / Region ZIP / Postal Code Dates of Employment: Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Your Position and DutiesReason for LeavingCurrent employer? Yes No May we contact this employer for a reference? Yes No References List below three persons not related to you who have knowledge of your work performance within the last three years.Name First Last PhoneOccupationNo. of Years AcquaintedAddress Street Address City State / Province / Region ZIP / Postal Code Name First Last PhoneNo. of Years AcquaintedOccupationAddress Street Address City State / Province / Region ZIP / Postal Code Name First Last PhoneOccupationNo. of Years AcquaintedAddress Street Address City State / Province / Region ZIP / Postal Code Name First Last PhoneOccupationNo. of Years AcquaintedAddress Street Address City State / Province / Region ZIP / Postal Code
