First Name
Last Name
Address
Main Phone
Cell Phone
Email
May we contact you at work?
Position(s) Applying for:
Are you able to meet the attendance requirements for the position(s) listed above
Data Available to Start
Desired Salary Range
Time of Employment Desired (check all that apply)
Shift(s) Available to Work (check all that apply)
Will you work overtime if required?
Have you ever submitted an application with Autumn Harp Inc. before?
Have you employed by Autumn Harp Inc. before?
Are you 18 years of age or older?
Are you currently a student?
Are you legally eligible for employment in the US?
Would you be willing to take a pre-employment drug test?
Employment History 1
Employer
Employer Phone
Employer Address, City, State, ZIP
Start Date
End Date
Starting Title / Ending Title
Immediate Supervisor and Title
May we contact for a reference?
Reason for leaving
Summarize the type of work performed and responsibilities of the job
Employment History 2
Employer
Employer Phone
Employer Address, City, State, ZIP
Start Date
End Date
Starting Title / Ending Title
Immediate Supervisor and Title
May we contact for a reference?
Summarize the type of work performed and responsibilities of the job
Reason for leaving
Employment History 3
Fill in if you have more employment history – scroll to the bottom and "continue" if you do not have more to fill in.
Employer
Employer Phone
Employer Address, City, State, ZIP
Start Date
End Date
Starting Title / Ending Title
Immediate Supervisor and Title
May we contact for a reference?
Summarize the type of work performed and responsibilities of the job
Reason for leaving
Employment History 4
Fill in if you have more employment history – scroll to the bottom and "continue" if you do not have more to fill in.
Employer
Employer Phone
Employer Address, City, State, ZIP
Start Date
End Date
Starting Title / Ending Title
Immediate Supervisor and Title
May we contact for a reference?
Summarize the type of work performed and responsibilities of the job
Reason for leaving
Special Training
Summarize any special training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position(s) for which you are applying.
Educational Background
School Attended
Number of Years Completed
Degree / Diploma
Major
Minor
Additional Education
School Attended
Number of Years Completed
Degree / Diploma
Major
Minor
Reference 1
Name
Phone
Company / Type of Reference
Reference 2
Name
Phone
Company / Type of Reference
Reference 3
Name
Phone
Company / Type of Reference
Additional Information
Please read before submitting.
I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.
I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable, local, state or federal law.
I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.
I understand and acknowledge that any offer of employment made to me by Autumn Harp is contingent upon the satisfactory completion of the medical process, including but not limited to testing for the use of certain drugs.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
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