First Response Application

Employment Application

All fields are required.

Name First Middle Last
Address
Street Address

Apartment

City

State

Postal / Zip Code
How long have you lived at this address? (in years)

Please enter in years how long you have resided at this address.
Phone - (###) - ### ####
Work Availability
Are you under 18 years of age? Yes No
If YES to the above questions, can you provide proof of your eligibility to work? Yes No
Proof of eligibility to work will be required if hired.
Are you currently authorized to work in the United States? Yes No
Proof of eligibility to work will be required if hired.
Position Applied For
Wage Desired $ . Dollars Cents
Employment desired?
When are you available to begin work? / MM / DD YYYY
Days Available to Work No Preference Monday Tuesday Wednesday Thursday Friday Saturday Sunday
How many hours can you work weekly?
Do you have a valid driver's license? Yes No
What is your means of transportation to work?
Education & Training
High School
Name

Major/Degree

# Years Attended

Address - City & State
College
Name

Major/Degree

# Years Attended

Address - City & State
Trade School
Name

Major/Degree

# Years Attended

Address - City & State
Graduate/Professional Degree
Name

Major/Degree

# Years Attended

Address - City & State
Miscellaneous Information
Have you ever been convicted of a felony? Yes No
A conviction record will not necessarily disqualify you from employment.
If YES, explain the number of conviction(s), nature of offense(s), leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.
References
Please list two references other than relatives.
Reference One
Name

Company

Position

Address - City & State

Phone Number
Reference Two
Name

Company

Position

Address - City & State

Phone Number
About You
Tell us about yourself.

Please use this space to elaborate on any background, experience, or qualifications which you beleve should be considered in evaluating your qualifications for employment. You may include hobbies, volunteer experience, and other activities that may be relevant. Please omit any information that would disclose your race, gender, age, marital status, ethnic origin, religious or political affiliations, or disability.
Have you ever been in the Armed Forces? Yes No
Armed Forces Specialty
Date entered Armed Forces / MM / DD YYYY
Date discharged from Armed Forces / MM / DD YYYY
Please list your work experience for the past 10 years beginning with your most recent job held.
Present or Most Recent Employer
Name

Company

Position

Address - City & State

Phone Number

If you were self-employed, give your firm's name
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
May we contact your present employer? Yes No
Did you complete this application yourself? Yes No
Pre-Employment inquiry Authorization release
In connection with my application for employment, I understand and agree that background inquires may be requested by you or on your behalf that will provide information as to my character, work habits, including oral assessments of my job performance, experiences, and abilities. Furthermore, I understand and agree that you may request information from various federal, state, and other agencies relating to my driving record, credit history, criminal record, civil matters, previous employment, educational background, and other past experiences. Yes No
I acknowledge that a telephonic facsimile, or copy, electronic or otherwise, of this release shall be as valid as the original. This release is valid for all federal, state, county, and local agencies and authorities. Yes No
I understand if I am hired, a one-time fee of $25 will be deducted from my first paycheck and after 90 days, if I am still employed with First Response, I will be reimbursed for this fee. Yes No
The following is my complete and legal name, and all information is true and correct to the best of my knowledge. First Middle Last
Driver's Liscence Information
Drivers Liscence Number

State Issued
When was your liscence issued? / MM / DD YYYY
When were you born? / MM / DD YYYY
Social Security Number - (###) - ## ####
Former Names (and corresponding date of change, if applicable):
Personality Test
When do you feel your best?
You usually walk...
When talking to people you...
When relaxing, you sit with...
When something really amuses you, you react with...
When you go to a party or social gathering you...
You're working very hard, concentrating hard, and you're interrupted Do you...
Which of the following colors do you like the most?
When you are in bed at night, in those last few moments before going to sleep, you lie…
You often dream that you are...

First Response Application

Employment Application

Work Availability

Education & Training

Miscellaneous Information

References

About You

Pre-Employment inquiry Authorization release

Personality Test