SumiRiko Tennessee
Tazewell's Application for Employment

We consider applications for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation or any other legally protected status.

Position(s) Applied for

Date of Application

     

First Name

Middle Name

 

Last Name

Address

Number

Street

City

State

Zip Code

Telephone Number(s)

Emergency Contact Telephone Number

 

 

 

 

 

 

If you are under 18 years of age, can you provide required proof of your eligibility to work?

YES

NO

Can you travel if a job requries it?

YES

NO

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status

YES

NO

Are you currently on "lay-off" status and subject to recall?

YES  NO

Have you been convicted of a felony within the last 7 years?

YES

NO

If Yes, please explain

Proof of citizenship or immigration status will be required upon employment
Conviction will not necessarily disqualify an application from employment
WE ARE AN EQUAL OPPORTUNITY EMPLOYER

 

Education

Elementary School

 Address of School

Course of Study

Years Completed

Diploma Degree

High School

Address of School

Course of Study

Years Completed

Diploma Degree

Undergraduate College

Address of school

Course of Study

Years Completed

Diploma Degree

Graduate Professional

Address of school

Course of Study

Years Completed

Diploma Degree

Other (Specify)

Address of school

Course of Study

Years Completed

Diploma Degree

 

Indicate any foreign languages you can speak, read and / or write

Speak

Select Proficiency

Fluent Good Fair

Read

Select Proficiency

Fluent Good Fair

Write

Select Proficiency

Fluent Good Fair

 

  Employment Experience (Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.)

Employer

Phone

Address

Supervisor

Job Title

Starting Salary

$

Ending Salary

$

Responsibilities

From

To

Reason for Leaving

 

 

Work Performed

Employer

Phone

Address

Supervisor

Job Title

Starting Salary

$  

Ending Salary

$  

Responsibilities

 

From

 

To

 

Reason for Leaving

 

   

Work Performed

Employer

 

Phone

 

Address

 

Supervisor

 

Job Title

 

Starting Salary

$  

Ending Salary

$  

Responsibilities

 

From

 

To

 

Reason for Leaving

 

   

Work Performed

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Describe any job-related training received in the United States military.

 

 

 

References

Applicant's Statement

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

 

I authorize investigation of all statements contained in this application for employment as

may be necessary in arriving at a employment decision.

 

This application for employment shall  be considered active for a period of time not to exceed

60 days.  Any applicant wishing  to  be considered for  employment beyond  this  time  period should inquire as to whether or not  applications are  being accepted at that time.

 

I hereby  understand and  acknowledge that, unless otherwise defined  by applicable law, any employment relationship with  this  organization is of an  "at will" nature, which  means  that the Employee may resign  at any time and the Employer may discharge Employee at any time with  or without cause.  It is further understood that this  "at will" employment relationship may not  be changed by any written document or by conduct  unless such change is specifically acknowledged in writing by an authorized executive of this organization.

 

In the  event  of employment, I understand that false or misleading information given in my application or interview(s) may result  in discharge. I understand, also, that I am required  to abide  by all rules  and regulations of the employer.

 

I have read and accept these terms

Date: