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Application for Employment Please fill out and Submit. Printer-friendly Fax/Mailable click here.


PROVIDE ALL INFORMATION REQUESTED BY FILLING OUT OR PRINTING IN INK. Please read carefully before you sign this application. False statements on this application form shall be considered sufficient cause for termination. Qualified applicants receive consideration for employment without discrimination because of sex, marital status, race, color, creed, religion, national origin, age, the presence of a disability, or status as a disabled or Vietnam-era veteran.

Full Name:
Address:
City:
State:
Zip:
Phone:
E-Mail:
 
ARE YOU LEGALLY ELIGIBLE FOR EMPLOYMENT IN THE U.S.A.?
Yes No
Date Available:   Desired Salary:      

Position Applied for:

Check all shifts you are willing to work:
Full Time Part Time Temporary Night Day Graveyard

Will you be able to perform the duties for which you are applying for, with or without accommodation?
Yes No

List any relatives and/or friends
working for Mt. Spokane





Are you a citizen of the United States?
Yes No

If no, are you authorized to work in the U.S.?
Yes No
Have you ever worked for this company?
Yes No 		If so, when?
Have you ever been convicted of a felony?
Yes No 		If yes, explain:
   
   
Education & Training  
   
High School College Other
Name: Name: Name:
Address: Address: Address:
From To From To From To
Did you graduate? Yes No Did you graduate? Yes No Did you graduate? Yes No
Degree: Degree: Degree:
 
Special Skills relevant to position applied for:
 
Volunteer Work:
 
Certificates, Licenses held:
 
Languages Read, Written or Spoken Fluently other than English:
 
 
References
 
Please list three professional or personal references.

Reference #1 Reference #2 Reference #3
Full Name: Full Name: Full Name:
Company: Company: Company:
Relationship: Relationship: Relationship:
Address: Address: Address:
Phone: Phone: Phone:
 
Previous Employment
 
Employer #1
Company: Address: Phone:
           
Supervisor: Job Title:    
           
Starting Salary: Ending Salary:    

Responsibilities:
From: To: Reason for Leaving:
 
May we contact your previous supervisor for a reference? Yes No
 
Employer #2
Company: Address: Phone:
           
Supervisor: Job Title:    
           
Starting Salary: Ending Salary:    

Responsibilities:
From: To: Reason for Leaving:
 
May we contact your previous supervisor for a reference? Yes No
 
Employer #3
Company: Address: Phone:
           
Supervisor: Job Title:    
           
Starting Salary: Ending Salary:    

Responsibilities:
From: To: Reason for Leaving:
 
May we contact your previous supervisor for a reference? Yes No
 
Military Service
Branch: From: To:
 
Rank at Discharge: Type of Discharge:
 
If other than honorable, explain:
 

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I agree

Signature: Date:

 
Please double check your application for accuracy.
Is there anything you missed or would like to add?
Thank You for applying to Mt. Spokane.
 
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