Employment Application « PKT Enterprises

Position applied for:*
Other:*
Name*
First Last
Address*
Street Address City State ZIP Code
Phone (Cell)*
Phone (Home)
Email*

Are you at least 19 years old?*
- Yes
- No
Have you ever been employed here before?*
- Yes
- No
Are you legally eligible for employment in this country?*
- Yes
- No
Date available for work:*
Date Format: MM slash DD slash YYYY
Desired salary range?*
Type of employment desired:*
- Full-Time
- Part-Time
How did you hear of us?*
Driver's License #:*
Having a valid driver's license is an essential function of the job. Authorization for pre-hire MVR screen.

Provide the following information of your last four (4) employers, assignments, or volunteer activities starting with the most recent. If you have less than four you can skip additional employment sections.
Employer*
Dates Employed - From & To:*
Phone*
Job Title*
Supervisor Name and Title*
May we contact?*
- Yes
- No
Summarize the nature of work performed and job responsibilities*
Reason for Leaving*

Provide the following information of your last four (4) employers, assignments, or volunteer activities starting with the most recent. If you have less than four you can skip additional employment sections.
Employer
Dates Employed - From & To:*
Phone*
Job Title*
Supervisor Name and Title*
May we contact?*
- Yes
- No
Summarize the nature of work performed and job responsibilities*
Reason for Leaving*

Provide the following information of your last four (4) employers, assignments, or volunteer activities starting with the most recent. If you have less than four you can skip additional employment sections.
Employer
Dates Employed - From & To:*
Phone*
Job Title*
Supervisor Name and Title*
May we contact?*
- Yes
- No
Summarize the nature of work performed and job responsibilities*
Reason for Leaving*

Provide the following information of your last four (4) employers, assignments, or volunteer activities starting with the most recent. If you have less than four you can skip additional employment sections.
Employer
Dates Employed - From & To:*
Phone*
Job Title*
Supervisor Name and Title*
May we contact?*
- Yes
- No
Summarize the nature of work performed and job responsibilities*
Reason for Leaving*

References - Please include 2 professional and 1 personal references.
Reference Name*
Relationship*
Phone*
Years Known*
Reference Name*
Relationship*
Phone*
Years Known*
Reference Name*
Relationship*
Phone*
Years Known*

Applicant Statement*
I agree to the applicant statement.
- 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 employers 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 any 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 application 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 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 of America and that federal immigration laws require me to complete an 1-9 form in this regard.
Electronic Signature*
By typing your name in the field above, you acknowledge that your electronic signature is the legal equivalent of your manual signature. You are certifying that you have read, fully understand, and accept all terms of the foregoing Applicant Statement.

Employment Application

Step 1 of 11 - Personal Information