Application for Employment

General
Thank you for your interest in a career at Polen Implement. To apply for a position, please fill out and submit the following form.
First Name:
Last Name:
Address:
Telephone:
Date Available for Employment
General
If employed and under 18, can you furnish a work permit?

Have you ever been employed by this company?

Are you employed now?
May we contact your present employer?
If yes, give name:
Are you prevented from lawfully becoming employed in this country because of visa or immigration status?
General
Type of work desired:
If applying for a position where driving is required, do you have a valid driver's license in this state?

License #:
Can you perform the essential functions of the job(s) for which you are applying?

Are you available to work:


Have you been convicted of a felony?
(Please note that a "Yes" answer will not bar you from consideration for employment.

If yes, please explain:
Education
Please list the school name, address and number of years completed:
Elementary:

Years Completed:
Secondary:
 
Years Completed:
College:


 

Years Completed:

Graduate:


   
Years Completed:
_____________________________________________________________
Special Skills, Qualifications and Considerations
Sumarize Special skills and qualifications, volunteer activities, military experience, employment or other activities related to the job you are seeking:

_____________________________________________________________
References
List three (3) non-relatives who are familiar with your qualifications, work history, and ability.
Name: Relationship: Years Known Telephone
Employment Experience (1/3)
Employer Name:

Supervisor's Name:
Address:

Your Job Position:
Telephone Number:

Employed from:
to
Your Salary: Starting/Ending:

Duties:
What did you like most about your job?
Reason for leaving?
Employment Experience (2/3)
Employer Name:

Supervisor's Name:
Address:

Your Job Position:
Telephone Number:

Employed from:
to
Your Salary: Starting/Ending:

Duties:
What did you like most about your job?
Reason for leaving?
Employment Experience (3/3)

Supervisor's Name:
Address:

Your Job Position:
Telephone Number:

Employed from:
to
Your Salary: Starting/Ending:

Duties:
What did you like most about your job?
Reason for leaving?
Agree and Submit
PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING THIS APPLICATION. ONLY THOSE APPLICATIONS THAT ARE SIGNED AND DATED ARE CONSIDERED VALID. IF YOU HAVE ANY QUESTIOS REGARDING THIS STATEMENT, PLEASE ASK THEM BEFORE SIGNING.

I certify that all answers and statements I have made on this application (and resumé or other Supplementary materials) are true and complete without omissions. By signing below, I authorize Polen Implement to investigate all statements contained in this employment application as they deem necessary in arriving at an employment decision. I understand that nay false information provided by me will likely result in a refusal to hire or immediate discharge if I am employed. I authorize any of the persons or organizations named in this application to give you complete information and records regarding my employment, education, character and qualifications.

If hired I will be responsible for familiarizing myself with all rules and regulations of Polen Implement as they presently exist or are later modified. If hired, I understand my Employment can be terminated, at the discretion of Polen Implement or at my option, without notice, at any time and for any reason. I understand this application is not an offer of employment and no promises or representations of employment have been made to me at this time. I have read, understand, and agree with the above.

Signature:
Date: