AE Employment Application

Thank you for your interest in employment with Advanced Employment, Inc. Please complete the application and authorization forms below. Someone from our office will follow up with you as soon as possible.

APPLICATION PART I: Fill out the application and submit

AE Job Application Form

Date: *

Available Start Date: *

Type of Employment Desired *

Full Time

Part Time

Days/Hours per week *

Position Applying For:

Name: *

First

Last *

Last

Address: *

Phone: (cell) *

(home) *

(work) *

Email: *

Social Security: *

DOB: *

If under 18, do you have a work permit. If not, why? *

Best time and preferred way to reach you: *

Drivers License (include State): *

Do you have a car available for work use? *

List Relevant Skills, Training & Qualifications for this Position *

Have you ever been convicted of a felony or released from prison in the past 10 years? (If yes, the nature of offense & date will be considered in determining eligibility) *

Any other commitments that may affect your employment? *

WORK EXPERIENCE: Employer #1

Address: (street / city / state / zip)

Position

Dates of Employment:

Hours per week:

Pay/Rate:

Description of Responsibilities:

Reason for Leaving:

Reference Y / N

Supervisor/Reference Contact Information:

WORK EXPERIENCE: Employer #2

Address: (street / city / state / zip)

Position

Dates of Employment:

Hours per week:

Pay/Rate:

Description of Responsibilities:

Reason for Leaving:

Reference Y / N

Supervisor/Reference Contact Information:

WORK EXPERIENCE: Employer #3

Address: (street / city / state / zip)

Position

Dates of Employment:

Hours per week:

Pay/Rate:

Description of Responsibilities:

Reason for Leaving:

Reference Y / N

Supervisor/Reference Contact Information:

EDUCATIONAL BACKGROUND: High School

Address

Degree

YES

Major

EDUCATIONAL BACKGROUND: GED

Address

Degree

YES

Major

EDUCATIONAL BACKGROUND: Trade/Business/Other

Address

Degree

YES

Major

APPLICATION PART II: Authorization Signature

Please read carefully and sign the following Authorization and Certificate form.

I authorize Advanced Employment, Inc. to make inquiry information from any person or organization regarding my suitability for employment, and give my permission to these persons or organizations harmless from any liability for the release of said information. Such information may include and not be limited to the quality and quantity of my work, work history, character, qualifications, educational record, records of convictions and medical records. I understand that the information obtained may be such as to disqualify me from employment. I understand that such information is sought with confidentiality, and I will not request copies of such information.

I certify that all statements made on this application are true and complete, accurate and not misleading to the best of my knowledge. I understand that false statements, incomplete statements, or misrepresentations may subject me to disqualification or dismissal. I understand that a photocopy of the authorization shall be as effective of the original.

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