Extended Family Application For Employment

Contact Info

First Name *

Last Name *

Street Address *

Apt #

City *

State *

Zip Code *

Phone Number *

Email Address *

Driver’s license # *

Driver’s license State *

Eligibility Info

Are you legally eligible for employment in this country? *

Yes

No

Will you work overtime if you are asked? *

Yes

No

Have you been convicted of a crime in the past 7 years that has not been annulled by a court? *

Yes

No

What position are you applying for? *

Do you have any special licenses or certifications? *

Education

Summarize any special skills/ qualifications acquired from other employment or other experiences that might enhance your qualifications to work at EF.

	Name & Location	Years Completed	Graduate?	Courses Studied
High School	Name & Location	Years Completed	Graduate?	Courses Studied
College	Name & Location	Years Completed	Graduate?	Courses Studied
Other	Name & Location	Years Completed	Graduate?	Courses Studied

Employment History

List last 3 employers, assignments, or volunteer activities, starting with the most recent, including

military experience

Previous Position #1

Company Name *

Company Address *

Job Title *

Duties *

Supervisor Name *

Supervisor Title *

Supervisor Phone Number

Start Date * +

End Date * +

Starting Pay *

Ending Pay *

Reason For Leaving *

Previous Position #2

Company Name *

Company Address *

Job Title *

Duties *

Supervisor Name *

Supervisor Title *

Supervisor Phone Number

Start Date * +

End Date * +

Starting Pay *

Ending Pay *

Reason For Leaving *

Previous Position #3

Company Name *

Company Address *

Job Title *

Duties *

Supervisor Name *

Supervisor Title *

Supervisor Phone Number

Start Date * +

End Date * +

Starting Pay *

Ending Pay *

Reason For Leaving *

Terms

Terms of Application

It is understood and agreed that any misrepresentation by me in this application will be sufficient
cause for cancellation of this application and/or separation from Extended Family’s service if I
have been employed. Furthermore, I understand that Extended Family is an at-will employer,
and just as I am free to resign at any time, Extended Family reserves the right to terminate my
employment at any time, with or without prior notice and with or without cause.

I understand that no representative of Extended Family has the authority to make any assurances to

the contrary. I understand that due to the variable nature of this business, there is no guarantee for

any minimum or maximum number of hours.

I give Extended Family the right to investigate all references and to secure additional
information about me if job-related. I give Extended Family permission to provide a reference to
any company or individual who may inquire either during or after my employment with Extended
Family. I hereby release from liability Extended Family and its representatives for seeking such
information and all other persons, corporations, or organizations for furnishing such information.

Extended Family is an equal opportunity employer. Extended Family does not discriminate in
employment and no question on this application is used for the purpose of limiting or excluding
any applicant’s consideration for employment on a basis prohibited by local, state, or federal law.

By signing below you understand and agree to the Terms of Application above *

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