Assumption Coop - Employment Application

First Name

Last Name

Street Address

City

State

Zip Code

Home Phone

Work Phone

Email

Are you over 18?

Yes

No

Have you ever been employed by Assumption Coop or an associated company?

Yes

No

(If yes, when and where)

Have you ever been convicted of a felony?

Yes

No

If, yes, state nature and date of offense. Conviction of a crime is not an automatic bar to employment – all circumstances will be considered.

Education & Training

High School Name & location of school

High School Dates Attended (From/To)

Degree/ Hr

GPA Major

GPA Overall

College Name & location of school

Major/ Minor

Dates Attended (From/To)

Degree/ Hr

GPA Major

GPA Overall

Other ( Trade or Business School, Military, ect.) Name & Location

Major/ Minor

Dates Attended (From/To)

Degree/ Hr

GPA Major

GPA Overall

Skill-Knowledge-Aptitude.

Check any of the following in which you have skill, knowledge or aptitude:

Greatest employment related strengths (skills, knowledge and aptitudes or personal strengths, i.e. dependability, motivation ect)

Employment History

Most recent employer

Address

Your Position(s)

Dates Employed (From/To)

Annual Salary $

Supervisor

PHONE

Describe your responsibilities

Reason for leaving

If currently employed may we contact your employer?

Yes

No

Employer

Address

Your Position(s)

Dates Employed (From/To)

Annual Salary $

Supervisor

Phone

Describe Your Responsibilities

Reason for leaving

If currently employed may we contact your employer?

Yes

No

Employer

Address

Your Position(s)

Dates Employed (From/To)

Annual Salary $

Supervisor

Phone

Describe Your Responsibilities

Reason for leaving

Professional Summary

List any professional accomplishments, licenses, certifications, associations, honors or awards, which relate to the position(s) for which you are applying.

Personal References (Not Former Employers or Relatives)

Name & Occupation

Address

Relationship

Phone

Name & Occupation

Address

Relationship

Phone

Name & Occupation

Address

Relationship

Phone

Name & Occupation

Address

Relationship

Phone

Employment Preferences

What types of work are you seeking?

Full-Time

Part-Time

What are your reasons for these choices?

Location Preference or Restrictions ( explain):

Date Available

Salary Expected

Please Read Carefully I authorize this firm to investigate my previous experience and qualifications and hereby release any parties furnishing such information from any resulting liabilities for damage. I declare the foregoing information to be truthful and complete statement of the facts with the understanding that if found false, it may prevent my being hired or may cause my dismissal if hired. I agree to furnish proof of my eligibility to work in the United States. I agree to cooperate with all Drug Free Workplace regulations which may include a post-offer drug test. I hereby acknowledge that I have read this application in its entirety, and understand that this application is not a contract of employment and that any individual who is hired may voluntarily leave employment or be terminated at any time by the employer. I understand that any oral or written statement to the contrary is hereby expressly disavowed, and should not be relied upon by any prospective or existing employee.

Type Name for Signature

Date

Required field