Employment Application
* These are required fields.
Position(s) Applied For: *
Referred By: Reference Code:
First Name: * Middle Name: Last Name: *
Home Phone: * Alternate Phone:
Address: * City: * State: * Zip: *
Have you ever filed an application with us before? * Yes No If yes, when:
Have you ever been employed with us before? * Yes No If yes, when:
Are you currently employed? * Yes No  
May we contact your current employer? * Yes No  
Are you authorized to be employed by any employer in the U.S.? * Yes No  
Are you a Permanent Resident or U.S. Citizen? * Yes No  
Have you ever been convicted of a crime? * Yes No If yes, state the crime and date:
Date Available for work: * Desired Hourly Wage: * $ /hour
Are you available to work: *
Full-Time (please indicate 1st, 2nd, or 3rd shift)
Part-Time (please indicate Mornings, Afternoons, Evenings)
Temporary (please indicate dates available to )


Resume:
Please upload your resume here:
File types allowed: DOCX and PDF. Maximum filesize: 3MB.


Education:
  Name & Address Of School Course of Study Years Completed Diploma/Degree
High School
Undergraduate College
Graduate Professional
Please list: Any other specialized training, apprenticeship and/or extra-curricular activities.


Previous Employment:
Employer:
Address:
Supervisor:
Hourly Wage:
Phone Number:
Job Title:
Dates Employed: to
Reason for Leaving:
Duties/Responsibilities:    
Employer:
Address:
Supervisor:
Hourly Wage:
Phone Number:
Job Title:
Dates Employed: to
Reason for Leaving:
Duties/Responsibilities:    
Employer:
Address:
Supervisor:
Hourly Wage:
Phone Number:
Job Title:
Dates Employed: to
Reason for Leaving:
Duties/Responsibilities:    
Employer:
Address:
Supervisor:
Hourly Wage:
Phone Number:
Job Title:
Dates Employed: to
Reason for Leaving:
Duties/Responsibilities:    


References:
Name Phone Number Address

I certify that the answers given here are true and complete. I authorize investigation into all statements contained in this application. This application for employment shall be considered active for a period of 90 days. I understand that upon employment, as an Employee, I may resign at any time and the Employer may discharge an Employee at anytime with or without cause. In the event of employment, I understand that any false or misleading information in this application and or interview(s) may result in a discharge. I also understand that I am required to abide by all rules and regulations set forth by Perfekta, Inc.
I accept this statement. *


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