Employment Application

Availablility

Position Apply for
Date Available to Start (MM/DD/YYYY)
Desired Schedule













Full/Part/Temp Time





Days/Evenings



Personal Information

Full Name
PRESENT address
PRESENT City/State/Zip
PREVIOUS Address
PREVIOUS City/State/Zip
E-mail address
Daytime Telephone
Evening Telephone
Mobile Telephone
Are you over



Education (H.S., College, Other)
Academic/Professional honors

Employment History

Current Employer
Current Employer Address
Current Employer Telephone
Start Date (MM/DD/YYYY)
End Date (MM/DD/YYYY)
Final Salary/Hourly Rate
Reason for Leaving
Description of Duties
May we contact CURRENT employer



PREVIOUS Employer 1
PREVIOUS Employer 1 Address
PREVIOUS Employer 1 Telephone
Start Date (MM/DD/YYYY)
End Date (MM/DD/YYYY)
Final Salary/Hourly Rate
Reason for Leaving
Description of Duties
May we contact PREVIOUS Employer 1



PREVIOUS Employer 2
PREVIOUS Employer 2 Address
PREVIOUS Employer 2 Telephone
Start Date (MM/DD/YYYY)
End Date (MM/DD/YYYY)
Final Salary/Hourly Rate
Reason for Leaving
Description of Duties
May we contact PREVIOUS Employer 2



Miscellaneous

Is there any additional information involving a change of your name or assumed name that will permit us to check your work record?
Any change of name or assumed name?



IF changed/assumed name, please explain
Ever been convicted of a crime



If yes, please explain

References

Reference 1
Reference 2
Reference 3

Emergency Contact

Full Name
Address
Telephone
Place of Employment
Address
Telephone
Relationship to you

I hereby affirm that the information given by me on this application for employment is complete and accurate, I understand that any falsification will be immediate grounds for dismissal. I authorize a thorough investigation to be made in connection with this application concerning my character, general reputation, personal characteristics, employment, education background, and criminal record, whichever is applicable. I understand that this investigation may include personal interviews with third parties such as family members, business associates, financial sources, friends, neighbors, and others with whom I am acquainted.

It is my understanding that as a prerequisite to consideration for employment, I must agree to submit to any post-employment examinations, physical or other, as Wild Ride Staffing by lawfully require. The company will pay the reasonable cost of any such examination which may be required.

I understand and agree that any falsification or omission either on this form or in my response to questions asked during any interview or other examination process is grounds for immediate termination of my employment no matter when the falsification or omission is discovered.

If I am hired, I agree that my employment and compensation can be terminated with or without cause and without notice at any time, at the option of Wild Times Staffing or myself. I understand that no representative of Wild Ride Staffing other than a Co-owner has the authority to enter into and agreement for any specified period of time or to make any agreement contrary to the foregoing. I further understand that I have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of the nature and scope of the investigation.

I have read and affirm as my own the above statements.