applicationcareeroptions

EMPLOYMENT APPLICATION

Career Options, Inc.
726 North Main St, Carroll, Iowa 51401
Phone: 712-792-2830, Fax: 712-792-0029

Date Applied:

Federal law prohibits discrimination based on age, race, religion, sex or national origin. Information given through your application cannot and will not be used for any discriminatory purpose.

Last Name

First Name

Middle

Address

City

State

Zip

Home Phone

Cell Phone

Email Address

Hobbies/ Outside Interests

Bilingual Skills

Will you Travel

Yes No

Will you Relocate

Yes No

Are you registered with any other recruiting firms

Yes No

Employment Desired

Full time only Part time only Full or part time

Do you have a valid Driver’s license

Yes No

Are you legally eligible for permanent employment in the United States

Yes No

Are you currently employed

Yes No

How many hours can you work weekly

Can you work nights

Yes No

Are you over 18 years of age

Yes No

Have you ever been convicted of a crime (do not include traffic offences)

Yes No

If yes, list convictions (a conviction does not necessarily disqualify an applicant for the applied position)

Position applied for

Wage Desired

When are you available for work

MILITARY SERVICE

Branch of Service

From

To

Rank & Duties

Date Discharged

EDUCATIONAL HISTORY

High school

Location, City, State

From

To

Did you Graduate

Yes No

Degree

Technical/Trade

Location, City, State

From

To

Did you Graduate

Yes No

Degree

College(s)

Location, City, State

From

To

Did you Graduate

Yes No

Degree

Personal References (not a relative)

Full Name

Phone Number

Year Known

Full Name

Phone Number

Year Known

Full Name

Phone Number

Year Known

Other Skills

List Skills if Other

Employment History

Starting with present or most recent, list all previous employers. If more space is required, please continue on a separate sheet. You may attach resume but complete application as well below.

Last or present company

Type of business

Start Date

End Date

Company address

Company Phone no.

Supervisor's name and title

Supervisors Phone no.

Base salary or Per hour

Title and job description

Reason for leaving

Company

Type of business

Start Date

End Date

Company address

Company Phone no.

Supervisor's name and title

Supervisors Phone no.

Base salary or Per hour

Title and job description

Reason for leaving

Company

Type of business

Start Date

End Date

Company address

Company Phone no.

Supervisor's name and title

Supervisors Phone no.

Base salary or Per hour

Title and job description

Reason for leaving

Upload Resume

In case of an emergency, please contact

Full Name

Phone Number

All applicants will be considered for employment without regard to race, religion, color, sex, national origin, marital or veteran status, medical condition or handicap, or any other status protected by law. We are an Equal Opportunity Employer.

The above information is true and complete to the best of my knowledge. Should I be employed by Career Options, Inc., any misrepresentation or false statement contained here in may be considered cause for possible dismissal. Career Options Inc. has my permission to obtain all necessary information from the references I have listed, or any other sources, concerning my prior employment, personal history including criminal background checks or credit standing and I release all parties from any possible damages resulting from disclosing such information with or without prior written notice to me.

I understand this application does not constitute an employment contract of any kind. Should I be employed by Career Options, Inc., I may resign such employment at any time at my discretion with or without prior notice and Career Options, Inc. may terminate my employment at any time at their discretion, with or without cause and with or without prior notice.

Date

Signature of Applicant

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