Employee Application – Cattleya Services

EMPLOYER:

POSITION APPLYING FOR:

PERSONAL DATA

First Name *

Middle Name

Last Name *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Home Telephone Number

Business Telephone Number

Cellular Telephone Number *

Email Address *

Date you can start work *

Desired Salary *

Do you have a High School Diploma orGED?

POSITION INFORMATION

(Check all that you are willing to work)

Are you authorized to work in the U.S. on an unrestricted basis? *YesNo

Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.) *YesNo

If yes,explain:

Have you been told the essential functions of the job or have you viewed a copy of the job description listing the essential functions of the job? *YesNo

Can you perform these essential functions of the job with or without reasonable accommodation? *YesNo

QUALIFICATIONS Please list any education or training you feel relates to the position applied for that would help you performthe work, such as schools, colleges, degrees, vocational or technical programs, and military training.

SPECIALSKILLS List any special skills or experience that you feel would help you in the position that you are applying for(leadership, organizations /teams, etc.

REFERENCES Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don' t have three professional references , then list personal, unrelated references.

WORK HISTORY

Start with you present or most recent employment and work back. Use separate sheet ifnecessary. (INCLUDE PAID AND UNPAID POSTIONS)

JOB TILE #1

Start Date

End Date

Company Name

Supervisor’s Name

Phone Number

City

State/Province

ZIP / Postal Code

Duties

Reason for Leaving

Starting Salary

Ending Salary

MAY WE CONTACT YOUR PRESENT EMPLOYER? YesNo

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. Iunderstand that if l am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize theEmployer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. Theemployer may contact any listed references on this application.

I acknowledge and understand that the company is an "at will" employer. Therefore, any employee (regular, temporary, or othertype of categoryemployee) may resign at any time, just as the employer may terminate the employment relationship with anyemployee at any time, with or without cause, with or without notice to the other party.

Applicant Signature: *

Date

PERSONAL DATA

POSITION INFORMATION

​(​Check all ​that ​you ​are ​willing ​to ​work)

WORK HISTORY

Start with you present or most recent employment and work back. Use separate sheet ifnecessary. (​INCLUDE PAID AND UNPAID POSTIONS)

(Check all that you are willing to work)

Start with you present or most recent employment and work back. Use separate sheet ifnecessary. (INCLUDE PAID AND UNPAID POSTIONS)