EmailMe Form - Layton Systems Employment Application

Date

MM / DD / YYYY

Position(s) you're Applying for:

Referral Source:

APPLICANT INFORMATION

Name

First Middle Last

Maiden Name

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home Phone Number

### - ### - ####

Cell Phone Number

### - ### - ####

Email

Are you Employed Now?

Yes

No

May we Contact your Present Employer?

Yes

No

On what Date are you Available to Begin Work?

Expected Salary?

EDUCATION

SECONDARY SCHOOL

Year(s) Attended

School Name and State

Years Completed

9

10

11

12

Did you Graduate?

Yes

No

List Diploma or Degree

List Course of Study

COLLEGE/UNIVERSITY

Year(s) Attended

School Name and State

Years Completed

1

2

3

4

Did you Graduate?

Yes

No

List Diploma or Degree

List Course of Study

Year(s) Attended

School Name and State

MISCELLANEOUS

1. Special Skills and Qualifications: Summarize Special Skills and Qualifications Acquired from Employment of other Experience.

4. Have you been Convicted of any Misdemeanor or Felony in the Last Seven Years?

Yes

No

If Yes, Please give the Date(s) and Details:

NOTE: Answering “Yes” to question four does not constitute an automatic bar to employment. Factors such as the age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. (Do not include minor traffic citations and arrests or convictions which have been sealed or expunged).

EMPLOYMENT EXPERIENCE

Resumes may be attached to provide additional information.

Upload Resume

Employer

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####

Job Title

Supervisor

Reason for Leaving

	From	To
Dates Employed

	Starting $	Final $
Hourly Rate/Salary

Work Performed

Employer

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####

Job Title

Supervisor

Reason for Leaving

	From	To
Dates Employed

	Starting $	Final $
Hourly Rate/Salary

Work Performed

REFERENCES

Give name, address and telephone number of at least three personal references who are not related to you and are not previous employers.

Reference Name

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Daytime Phone Number

### - ### - ####

Reference Name

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Daytime Phone Number

### - ### - ####

CONDITIONS OF EMPLOYMENT

I authorize the references listed and former employers to give you any and all pertinent information they may have and release all parties from any liability concerning the information they release. I hereby certify that the information listed on this application is true and correct. I understand that if any false, incomplete or misleading information is given by me on this application, I will be disqualified for employment. Also, if such falsification of this application is discovered once I am employed, I understand it will constitute grounds for discipline up to and including immediate termination.

In the event of my employment to a position in this Company, I will comply with all rules and regulations of this Company. I understand that the Company reserves the right to require me to submit to a test for the presence of drugs in my system prior to employment and at any time during my employment, to the extent permitted by law. I understand and agree that refusal to take this test or positive test results may result in my employment being terminated.

If hired, I agree as follows: My employment and compensation is terminable at-will, is for no definite period, and my employment and compensation may be terminated by the Company at any time and for any reason whatsoever, with or without good cause at the option of either the Company or myself. No implied, oral or written agreements contrary to the express language of this agreement are valid unless they are in writing and signed by the President/CEO of the Company. No supervisor or representative of the Company, other than the President/CEO, has any authority to make any agreements contrary to the foregoing. This agreement is the entire agreement between the Company and the employee regarding the rights of the Company and or employee to terminate employment with or without good cause, and this agreement takes the place of all prior and contemporaneous agreements, representations, and understandings of the employee and the Company.

Do not write your name below until you have read the above statement and agree.

Please write in your name and todays date below