
Employment Application
The information given on this form is solely for the use of Gajeske, Inc. and will be held in the strictest confidence. It will be to the applicant’s advantage to answer each question fully and accurately. The use of this form does not indicate that there are any positions open and does not obligate the Company in any way. Gajeske, Inc is an Equal Opportunity Employer and does not discriminate against applicants or employees on the basis of race, color, sex, age, religion, national origin, or disability.
Personal | |||
First Name | Middle Name | Last Name | Email Address |
[First-name] | [Middle-name] | [Last-name] | [your-email] |
Personal Address - Street | City, State | Zip | Contact Telephone Number |
[Present-Address] | [Present-city-state] | [Present-zip] | [Present-phone] |
Alternate Address - Street | City, State | Zip | Alternate Telephone Number |
[Alternate-Address] | [Alternate-city-state] | [Alternate-zip] | [Alternate-phone] |
Referred by | Date Available for Employment | Eligible to work in United States? | |
[Referred-by] | [Date-available] | [eligible-to-work] | |
Position(s) Applied For: | Starting Salary Desired | Geographical Locations Preferred | |
[Positions-applied] | [Starting-salary] | [Geographical-locations] | |
Are you willing to travel? | Are you willing to work overtime? | Are you willing to transfer? | |
[personal-travel] | [personal-overtime] | [personal-transfer] | |
Are you at least 18 years of age? | Have you previously worked for our company? | ||
[age-requirement] | [previous-employee] |
Employment Background | |||
Present (or last) Company Name | Address | City, State | Phone # |
[Employer-Name-1] | [Employer-Address-1] | [Employer-city-state-1] | [Employer-phone-1] |
Start Date | End Date | Starting Salary | Ending Salary |
[Employer-start-date-1] | [Employer-end-date-1] | [Employer-start-salary-1] | [Employer-end-salary-1] |
Job Title | Supervisor | Reason for Leaving | May we contact? |
[Employer-job-title-1] | [Employer-supervisor-1] | [Employer-reason-leaving-1] | [Employer-contact-1] |
Brief description of duties (include number of persons supervised, if applicable) | |||
[Employer-job-description-1] | |||
Previous Company Name | Address | City, State | Phone # |
[Employer-Name-2] | [Employer-Address-2] | [Employer-city-state-2] | [Employer-phone-2] |
Start Date | End Date | Starting Salary | Ending Salary |
[Employer-start-date-2] | [Employer-end-date-2] | [Employer-start-salary-2] | [Employer-end-salary-2] |
Job Title | Supervisor | Reason for Leaving | May we contact? |
[Employer-job-title-2] | [Employer-supervisor-2] | [Employer-reason-leaving-2] | [Employer-contact-2] |
Brief description of duties (include number of persons supervised, if applicable) | |||
[Employer-job-description-2] | |||
Previous Company Name | Address | City, State | Phone # |
[Employer-Name-3] | [Employer-Address-3] | [Employer-city-state-3] | [Employer-phone-3] |
Start Date | End Date | Starting Salary | Ending Salary |
[Employer-start-date-3] | [Employer-end-date-3] | [Employer-start-salary-3] | [Employer-end-salary-3] |
Job Title | Supervisor | Reason for Leaving | May we contact? |
[Employer-job-title-3] | [Employer-supervisor-3] | [Employer-reason-leaving-3] | [Employer-contact-3] |
Brief description of duties (include number of persons supervised, if applicable) | |||
[Employer-job-description-3] |
Education | |||
High School | Location | Diploma or GED Received? | |
[Education-hs] | [Education-hs-location] | [Education-diploma-ged] | |
College 1 | Location | Major | Type of Degree |
[Education-college-name-1] | [Education-college-location-1] | [Education-college-major-1] | [Education-college-degree-1] |
Start Date | End Date | Diploma Received? | Date of Graduation |
[Education-college-start-1] | [Education-college-end-1] | [Education-college-diploma-1] | [Education-college-graduation-date-1] |
College 2 | Location | Major | Type of Degree |
[Education-college-name-2] | [Education-college-location-2] | [Education-college-major-2] | [Education-college-degree-2] |
Start Date | End Date | Diploma Received? | Date of Graduation |
[Education-college-start-2] | [Education-college-end-2] | [Education-college-diploma-2] | [Education-college-graduation-date-2] |
College 3 | Location | Major | Type of Degree |
[Education-college-name-3] | [Education-college-location-3] | [Education-college-major-3] | [Education-college-degree-3] |
Start Date | End Date | Diploma Received? | Date of Graduation |
[Education-college-start-3] | [Education-college-end-3] | [Education-college-diploma-3] | [Education-college-graduation-date-3] |
Military | |||
Active Duty Branch | Active Duty Start Date | Active Duty End Date | Highest Rank Attained |
[Military-branch] | [Military-start] | [Military-end] | [Military-rank] |
Reserved Status | Reserved Branch | ||
[Military-reserve] | [Military-reserve-branch] |
Criminal | |||
Gajeske, Inc. will conduct a background check on all candidates selected for a position. While candidates with a criminal background will not be immediately excluded from consideration, Gajeske, Inc. reserves the right to exclude from consideration individuals who have a conviction within the past seven years for certain crimes, occurrence of multiple crimes, or frequency of the same crime(s). Failure to disclose criminal convictions within the last seven years on the background authorization acknowledgement/authorization (included with new hire paperwork for selected candidates) may result in immediate termination for falsifying a company document. | |||
[criminal-statement] |
Skills | |||
List office skills, trades, abilities or license certifications that may be beneficial in the job for which you are applying. | |||
[Skills-list] | |||
Foreign Languages | Degree of Proficiency | ||
[Skills-languages] | [skills-proficiency] |
References | |||
List three professional references most familiar with your abilities (supervisors preferred). | |||
Name and Association | Occupation | Email Address | Phone Number |
[Reference-name-1] | [Reference-occupation-1] | [Reference-email-1] | [Reference-phone-1] |
Name and Association | Occupation | Email Address | Phone Number |
[Reference-name-2] | [Reference-occupation-2] | [Reference-email-2] | [Reference-phone-2] |
Name and Association | Occupation | Email Address | Phone Number |
[Reference-name-3] | [Reference-occupation-3] | [Reference-email-3] | [Reference-phone-3] |
Applicant's Statement | |||
Applicant must review and accept I affirm that I have read and fully completed both sides of this application and all information as written above is true and correct. I acknowledge that I may be terminated at any time if any information I supply is false. I acknowledge that this application will remain active for no more than 45 days. If I wish to be considered for employment after this 45 day period, I will reapply. I understand that if I am employed by Gajeske, Inc. my employment and compensation can be terminated, with or without cause and with or without prior notice. I authorize the references listed on this application to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I furthermore authorize Gajeske, Inc. to conduct a background check so that they may confirm the information I have provided on this application is true and correct. Moreover, I authorize Gajeske, Inc. to require I pass a drug test to gain employment or remain employed with Gajeske, Inc. I grant Gajeske, Inc. the right to withhold, retain or deduct an amount up to and including the total amount of indebtedness, advances, charges for personal purchase on Company accounts, or any other amounts owed to Gajeske, Inc., or any of its affiliates, subsidiaries, or divisions, from my salary, wages, commissions, reimbursements or final pay subject to compliance with applicable state and federal wage and hour laws. I understand that I am required to abide by all rules and regulations of Gajeske, Inc. I acknowledge that these policies and procedures, and any benefits or other terms and conditions of my employment, may be changed, interpreted, withdrawn or added to by the Company at any time without prior notice to me. | |||
[applicants-statement] |
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