JM Murray | Application

Basic Information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone*

Mobile/Other Phone

Email

Date*

Position(s):

Referral Source

If necessary, the best time to call you is:

:

At which number?

Phone
Mobile/Other

May we contact you at work?

Yes
No

If yes, work number:

Best time:

:

If you are under 18 and it is required, can you furnish a work permit?

Yes
No

If no, please explain:

Have you submitted an application here before?

Yes
No

If yes, please give date(s) and position(s):

Have you ever been employed here before?

Yes
No

If yes, start date:

End date:

Job Title:

Is this application a request for reemployment following an extended military leave of absence from this company?

Yes
No

If yes, additional information may be requested.

Are you legally eligible for employment in this country?*

Yes
No

Date available for work:

Type of employment desired:*

Full-Time
Part-Time
Temporary

Will you relocate if the job requires it?

Yes
No

Will you travel if the job requires it?

Yes
No

If they have been explained to you, are you able to meet the attendance requirements of the position?

N/A
Yes
No

Will you work overtime if required?

Yes
No

If no, please explain:

Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)?:

This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

Yes
No
Need more info

Driver's license number required if driving may be required in the job for which you are applying:

Driver's License Number	State

Have you ever been bonded?

Yes
No

Have you ever been convicted of a misdemeanor or felony?*

Answering "yes" to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

Yes
No

If yes, please provide date(s) and details:

Have you entered into an agreement with any former employer or other party (such as a noncompetition agreement) that might, in any way, restrict your ability to work for our company?

Yes
No

If yes, please explain:

Employer History

Begin with your current or most recent employer.

Employer 1

You may include any verified work performed on a volunteer basis

Employer Phone Number

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title/Position

Starting Title Final Title

Immediate Supervisor

Name Title/Position

May we contact for a reference?

Yes
No
Later

If later, when may we contact?

Start Date:

End Date:

Why did you leave?

Summarize the type of work performed and job responsibilities:

What did you like most about your position?

What were the things you liked least about the position?

Employer 2

You may include any verified work performed on a volunteer basis

Employer Phone Number

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title/Position

Starting Title Final Title

Immediate Supervisor

Name Title/Position

May we contact for a reference?

Yes
No
Later

If later, when may we contact?

Start Date:

End Date:

Why did you leave?

Summarize the type of work performed and job responsibilities:

What did you like most about your position?

What were the things you liked least about the position?

Employer 3

You may include any verified work performed on a volunteer basis

Employer Phone Number

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title/Position

Starting Title Final Title

Immediate Supervisor

Name Title/Position

May we contact for a reference?

Yes
No
Later

If later, when may we contact?

Start Date:

End Date:

Why did you leave?

Summarize the type of work performed and job responsibilities:

What did you like most about your position?

What were the things you liked least about the position?

Please explain any gaps in your employment, other than those due to personal illness, injury or disability:

If not addressed above, have you ever been fired or asked to resign from a job?

Yes
No

If yes, please explain:

Skills & Qualifications

Summary

Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying:

Computer Skills

Check appropriate boxes. Include software titles and years of experience below (click the + to add more rows).

Word Processing
Spreadsheet
Email/Internet
Other

Computer Skills

Software Title	Years of Experience

Educational Background

Education

Begin with your current or most recent school attended.

Institution Name	Years Completed	Minor/Major	Diploma/Degree

References

List names and telephone numbers of two professional references and two personal references who are not related to you and are not previous supervisors. If not applicable, list school or personal references who are not related to you.

Professional Reference 1

Name*

Title*

Phone*

Email

Relationship to You*

Years Known*

Professional Reference 2

Name*

Title*

Phone*

Email

Relationship to You*

Years Known*

Personal Reference 1

Name*

Title*

Phone*

Email

Relationship to You*

Years Known*

Personal Reference 2

Name*

Title*

Phone*

Email

Relationship to You*

Years Known*

Related Information

List special accomplishments, publications, awards, etc.:

Exclude information that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve, National Guard or any other similarly protected status.

Is there any other job-related information you want us to know about you?

Resume

Applicant Statement

DO NOT CHECK THE BOX UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

Consent*

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.

This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status. Examples of prohibited harassment include, but are not limited to, unwelcome physical contact, offensive gestures, unwelcome comments, jokes, epithets, threats, insults, name-calling, negative stereotyping, possession or display of derogatory pictures or other graphic materials, and any other words or conduct that demean, stigmatize, intimidate, or single out a person because of his/her membership in a protected category. Harassment of our employees is strictly prohibited, whether it is committed by a manager, coworker, subordinate, or non-employee (such as a vendor or customer). The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer’s service, whenever it is discovered.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.*

Applicant Name*

First Last

Date*

Name

This field is for validation purposes and should be left unchanged.

Application

Application for Employment

Basic Information

Employer History

Skills & Qualifications

Educational Background

References

Related Information

Resume

Applicant Statement