Employment Application

Employment Desired

Seasonal

Part-time

Full-time

Applicant Details

Are you 18 years or older?

18 or older

Younger than 18

Last Name

First Name

Middle Name

Date

Present Street Address

City

State

Zip

Primary Phone

Secondary Phone

Emergency Contact (Name & Number)

Educational Background

Highschool:

Name:

City/State:

Years Attended:

Degree:

Major:

College:

Name:

City/State:

Years Attended:

Degree:

Major:

Graduate School:

Name:

City/State:

Years Attended:

Degree:

Major:

Job Experience

Note: We will contact the employers listed on this application unless you specifically exclude them below. (List below the last three employers, starting with the last one first)

Most recient/current position:

Start date:

End date:

Name of Employer:

Address of Employer:

Employers Phone Number:

Type of Business:

Salary:

Position Held:

Reason for Leaving:

Previous Position:

Start date:

End date:

Name of Employer:

Address of Employer:

Employers Phone Number:

Type of Business:

Salary:

Position Held:

Reason for Leaving:

References

Please list two professional references.

Full Name

Relationship

Company

Phone

Address

References

Full Name

Relationship

Company

Phone

Address

Military Service

Branch

Dates Served

Type of Discharge

Explain:

Background:

If hired, are you willing to submit to and pass a controlled substance test?

Yes

Have you been convicted of a felony?

Yes

If yes, please explain:

Email Address

Attach Resume if desired (Only PDF, .doc and .docx are accepted.)

Please Read and Initial Each Paragraph, then Sign Below
I certify that I have not purposely withheld any information that might adversely affect my chances for hiring.
I attest to the fact that the answers given by me are true & correct to the best of my knowledge and ability. I understand
and that any omission (including any misstatement) of material fact on this application or on any document used to secure can be
grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from the company.

____

I understand that if I am employed, my employment is not definite and can be terminated
by either me or the company at any time either with or without prior notice.
_____

I permit the company to examine my references, record of employment, education record, and any other information I have
provided. I authorize the references I have listed to disclose any information related to my work record and my professional
experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.
_____

Applicant's Signature:

__________________________________________________

Date:
_________________________________

An Equal Opportunity Employer
Summit is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from
consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable
accommodation in the application and/or interview process should notify a representative of the organization

Employment Application

Applicant Details

Employment Desired

Educational Background

Job Experience

References

References

Military Service

Background:

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