Application for Employment

Applicant Information
Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Date Available to start?*
Date Format: MM slash DD slash YYYY
Are you a citizen of the United States?*
- Yes
- No
Are you authorized to work in the US?
- Yes
- No
Have you ever been convicted of a felony?*
- Yes
- No
If yes, explain:
Position for which you are applying?
Are you able to perform the essential functions of the position for which you are applying with or without a reasonable accommodation?*
- Yes
- No

Additional Skills
Please describe skills relevant to the job for which you are applyihng
Sales Experience/Skills
Office Equipment (typing speed, programs, etc.)
Technical Skills, Professional Licenses
Other

References
Please provide three professional references, not a former supervisor
Reference 1 Name
First Last
Reference 1 Phone
Reference 2 Name
First Last
Reference 2 Phone
Reference 3 Name
First Last
Reference 3 Phone

Previous Employment
Most Recent Employmer
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Job Title
Supervisor
May we contact your previous supervisor for a refernce?
- Yes
- No
Starting Salary
Ending Salary
Responsibilities
Start and End Date
Reson for leaving?

2nd Most Recent Employer
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Job Title
Supervisor
May we contact your previous supervisor for a refernce?
- Yes
- No
Starting Salary
Ending Salary
Responsibilities
Start and End Date
Reson for leaving?

3rd Most Recent Employer
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title
Supervisor
May we contact your previous supervisor for a refernce?
- Yes
- No
Starting Salary
Ending Salary
Responsibilities
Start and End Date
Reason for leaving?

Resume/Cover Letter
Please attach a copy of your resume/cover letter. PDF, Word document, or .pages files are acceptable.

Accepted file types: rtf, doc, docx, pdf, pages.
Disclaimer*
The information provided in this Application for Employment is true, correct and complete. If employed, any misstatements or omissions of fact on this application may result in my dismissal. I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.

I understand that Shick Web Design, LLC is an Equal Opportunity Employer. No question on this application form is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state or federal law. Equal access to employment, services and programs is available to all persons.
- I Agree

Applicant Information