Personal Information |
Full Name:
Address:
City, State, Zip:
Phone:
Email:
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Employment Desired |
| Position Desired: |
Salary Expected: |
| On what date are you available to begin work? |
List any days or times you are not available to work: |
| Are you able to perform the essential functions of the job for
which you are applying with or without reasonable accommodation? |
Yes
No |
| Are you on lay-off and subject to recall? |
Yes
No |
| Have you filled out an application for Annapolis Carriage before? |
Yes
No
If yes, please give dates: |
| Have you been employed by Annapolis Carriage before? |
Yes
No
If yes, please give dates:
Reason for leaving: |
| How did you hear about employment opportunities at Annapolis Carriage? |
Referred by current employee
Flyer |
Website
Other |
Education |
Senior High School
Name
City, State
Number of Years:
9
10
11
12
Graduated?
Yes
No
Degree
|
College or University
Name
City, State
Number of Years:
1
2
3
4
Graduated?
Yes
No
Degree
|
Business or Technical School
Name
City, State
Number of Years:
1
2
3
4
Graduated?
Yes
No
Degree
|
Correspondence or Special School
Name
City, State
Number of Years:
1
2
3
4
Graduated?
Yes
No
Degree
|
| Please summarize special job-related skills and qualifications acquired
from education, employment, volunteer work or military service. |
|
| List any specific skills you have that will be helpful in performing the
responsibilities of the position(s) for which you are applying. |
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References |
| You must include at least two references who can
comment on your work habits, responsibility, character and conduct. |
Reference 1
Name:
Address:
Phone:
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Reference 2
Name:
Address:
Phone:
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Reference 3
Name:
Address:
Phone:
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Reference 4
Name:
Address:
Phone:
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Employment History |
Employer 1
Name:
Address:
City, State, Zip:
Phone:
Start Date:
End Date:
Salary/Hourly Rate:
Type of Work Performed:
|
Employer 2
Name:
Address:
City, State, Zip:
Phone:
Start Date:
End Date:
Salary/Hourly Rate:
Type of Work Performed:
|
Employer 3
Name:
Address:
City, State, Zip:
Phone:
Start Date:
End Date:
Salary/Hourly Rate:
Type of Work Performed:
|
Employer 4
Name:
Address:
City, State, Zip:
Phone:
Start Date:
End Date:
Salary/Hourly Rate:
Type of Work Performed:
|
| May we contact the employers listed above? |
Yes
No |
If no, indicate which one(s) you do
not wish us to contact.
If no, explain. |
| Have you ever been discharged or asked to resign from any position? |
Yes
No |
If yes, please state the employer
and dates of employment. |
| Have you ever been disciplined at a place of employment?
|
Yes
No |
If yes, explain:
|
| Which of the positions that you have held did you like best, and why? |
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| Which of the positions that you held did you like least, and why? |
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| Have you been convicted or plead guilty or no contest to a felony or
misdemeanor other than a minor traffic violation? |
Yes
No |
If yes, explain:
|
| Are any criminal charges pending against you?
|
Yes
No |
A conviction will not necessarily disqualify you from consideration. However, failure to
fully disclose will result in denial or termination of employment. |
Applicant's Statement |
| Please indicate that you have read and that you understand each paragraph of the Applicant’s Statement by clicking the radio button next to each statement. |
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1. |
I certify that this application (including each attachment to this application, if any) was completed by me and that all entries on it and all information in it are true and complete to the best of my knowledge. In the event of employment, I understand that false, misleading, or omitted information in my application may result in discharge. |
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2. |
I authorize investigation of all statements contained in this application for employment as may be helpful in arriving at an employment decision. In making this application for employment, I understand that an investigation may be made and information may be obtained through interviews with the personal references and past employers listed. This inquiry may include information as to my character, general reputation, and personal characteristics, as well as information about my work performance and workplace conduct. I consent to this investigation and to the consideration of any statements of references or former employers that are given in response to the inquiry. |
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3. |
I hereby release all parties, including but not limited to Annapolis Carriage, references, and previous employers, from any and all liability for any injury or damage that may result from their furnishing information to Annapolis Carriage concerning me or any action Annapolis Carriage takes on the basis of such information. |
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4. |
I understand that, if I am offered a job, as a condition of beginning my employment I will be required to undergo a physical examination, Mantoux TB test, drug and/or alcohol screens at any time thereafter as Annapolis Carriage deems necessary. I hereby authorize any doctor, hospital, clinic, laboratory or other medical facility to furnish any medical information with reference to me as may be necessary in conjunction with that examination and related consideration. |
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5. |
I understand that, according to federal law, all individuals who are hired must, as a condition of employment, produce certain documentation to verify their identity and United States citizen status or, if aliens, their legal authorization to work in the United States. As a consequence, I understand that any offer of employment to me by Annapolis Carriage is contingent upon my ability to produce the required documentation within the time period required by law. |
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6. |
I understand that this application is not, and is not intended to be, a contract of employment and that any resulting employment relationship is for no fixed period time and is terminable at any time for any reason by Annapolis Carriage, or by me. I further understand that statements which may be contained in policies, practices, handbooks, or other Annapolis Carriage material do not create any guarantee of employment and that Annapolis Carriage or its divisions has the right to modify, amend, or terminate policies, practices, benefit plans, or other programs within the limits and requirements imposed by law. I understand that no representative of Annapolis Carriage, other than the Executive Director or designee, has the authority to enter into any agreement for a specific period time or to make any agreement contrary to the foregoing and that any such agreement must be in writing to be binding on Annapolis Carriage. |
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7. |
By clicking the submit button, I understand that it is the equivalent of a signature on a printed application. |