Date * Last 4 numbers of Social Security Number * Address * City * State * Zip/Post Code * Length of Residence * Home/Cell Phone * Business Phone Email * Position Applying For * Date available for work * Are you at least 18 years of age? * If not please state your age Do you possess a valid drivers license? * Are you available to work * Skills and Qualifications * Certifications/Licenses applicable to the position applying for List any career objectives you may have Have you ever been convicted of a felony? * If so, when, and disposition of offense? School Name/Address/Telephone (Please list at least one) * Number of Years Completed * Area of Study School Name/Address/Telephone Number of Years Completed Area of Study Did you Graduate?
Begin with current/last position first. At least 7 years work history must be provided. (Feel free to email us more information if you need to.)
Company Name/Address/Telephone Supervisor Dates Month/Year From-To Position Held Rate of Pay Reason For Leaving May we contact your present employer? *
Please fill in
Company Name/Address/Telephone, Supervisor, Dates Month/Year From, Position Held, Rate of Pay, and Reason for Leaving
Give name, address, and telephone number of three references who are not related to you and not previous employers.
1 * 2 * 3 *
I understand and agree that: Any material misrepresentation or deliberate omission of a fact in my application may result in refusal of, or if employed, immediate termination from employment. Although management makes every effort to accommodate individual preference, business needs may at times make the following conditions mandatory, overtime, shift work, rotating work schedule, or work schedule other than Monday through Friday. I understand and accept these conditions my continuing employment. It is my understanding that Accord Human Resources will make a through investigation of my entire work history and may verify all data given in my application for employment, related papers, or oral interviews, that my employment is at will and may be terminated by Accord or myself at any time with or without notice or cause and without liability for wages or salary except such as may have been earned at the date of such termination. I further understand that this is an application for employment and that no employment contract is being offered, nor will any result from employment with Accord, I understand that if I am employed, such employment is for no definite period of time and that Accord can change wages, benefits and conditions at any time. I acknowledge that any oral representation or written statements which may have been made to me to the contrary of this paragraph are expressly disavowed and may not be relied upon.