Careers with Application Form

APPLICATION FOR EMPLOYMENT
Name*
First Middle Last
Address*
Number & Street Apt/Floor/Unit City State ZIP Code
Home Phone
Cell Phone
Position Sought
Shift Preferred
Full Time/ Part Time
Are you at least 18 years or older
- Yes
- No
Are you legally eligible for employment in the United States?
(If offered employment, you will be required to provide documentation to verify eligibility.)
- Yes
- No
Have you ever worked for Phoenix before?
- Yes
- No
If yes, where?
Approximate Date:
During the last ten years, have you ever been convicted of a crime other than a minor traffic offense? (A conviction will not necessarily automatically disqualify you for employment. Rather, such factors as age, date of conviction, seriousness and nature of the crime, and rehabilitation will be considered.)
- Yes
- No
If yes, please provide details (dates and location for all convictions):

REFERENCES
Provide the names of three persons not related to you, whom you have known at least three (3) years.
Name Address, Phone, Email Relationship Years Aquainted
APPLICANT’S CERTIFICATION AND AGREEMENT
Please read carefully before signing. I certify that all answers given by me are true, accurate and complete. I understand that the falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered. It is the policy of the company to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State or Local law. If hired, I agree to abide by all of the company rules and regulations, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the company or me. I further understand that no representation, whether oral or written by any representative or agent of the Company, at any time, can constitute a contract of employment. I acknowledge that I have read and understand the above statements.
Applicant Name*
First Last
Date*
Month
Day
Year
Untitled
Untitled

School(s)	City/State	Course	Degree/Certificate earned

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APPLICATION FOR EMPLOYMENT

EDUCATION

EMPLOYMENT HISTORY

REFERENCES

APPLICANT’S CERTIFICATION AND AGREEMENT

Name	Address, Phone, Email	Relationship	Years Aquainted