Supervisor Quality
Resume:
Employment Application
(For Use By Quality Pro Employers)
Today’s Date This is a Drug-Free Workplace Offering Equal Employment Opportunities
YOUR PERSONAL INFORMATION
Last Name First Name Middle Initial Home Telephone
Address City/State Zip Code Cellular Telephone
E-Mail Address
Home Telephone Cell Phone E-Mail
Preferred Method of Contact:
Other
YOUR WORK HISTORY AND ANY EMPLOYMENT GAPS
Must be completed even when accompanied by resume)
List most recent or current job first. You must include any gaps in employment, with a full explanation and dates for the ga p.
You must also provide a complete work history for a minimum of 15 years.
Employer Dates Employed Summary of Work Performed
& Job Responsibilities
From (Mo/Yr) To (Mo/Yr)
Address (City, State, Zip)
Phone:
Job Title Hourly Rate, Weekly Salary,
or Other Weekly Earnings
Starting Final
Resigned Terminated Supervisor’s Name
OR
State Reason:
E Employer Dates Employed Summary of Work Performed
& Job Responsibilities
From (Mo/Yr) To (Mo/Yr)
A Address (City, State, Zip)
Phone:
J Job Title Hourly Rate, Weekly Salary,
or Other Weekly Earnings
Starting Final
Resigned Terminated Supervisor’s Name
OR
State Reason:
E Employer Dates Employed Summary of Work Performed
& Job Responsibilities
From (Mo/Yr) To (Mo/Yr)
A Address (City, State, Zip)
Phone:
J Job Title Hourly Rate, Weekly Salary,
or Other Weekly Earnings
Starting Final
Resigned Terminated Supervisor’s Name
OR
State Reason:
Applications are received and employees are hired without regard to race, creed, color, sex, religion, age, national origin, physical or mental handicap,
disability, veteran’s status, citizenship status, or any other protected classes under state, local or county regulations. T he receipt of this application does
not mean that job openings exist and does not obligate us in any way. We appreciate your interest in our organization.
©Quality Pro Page 1 of 5 April 2006
MORE OF YOUR WORK HISTORY AND ANY EMPLOYMENT GAPS
Employer Dates Employed Summary of Work Performed
& Job Responsibilities
From (Mo/Yr) To (Mo/Yr)
Address (City, State, Zip)
Phone:
Job Title Hourly Rate, Weekly Salary,
or Other Weekly Earnings
Starting Final
Resigned Terminated Supervisor’s Name
OR
State Reason:
E Employer Dates Employed Summary of Work Performed
& Job Responsibilities
From (Mo/Yr) To (Mo/Yr)
A Address (City, State, Zip)
Phone:
J Job Title Hourly Rate, Weekly Salary,
or Other Weekly Earnings
Starting Final
Resigned Terminated Supervisor’s Name
OR
State Reason:
E Employer Dates Employed Summary of Work Performed
& Job Responsibilities
From (Mo/Yr) To (Mo/Yr)
A Address (City, State, Zip)
Phone:
J Job Title Hourly Rate, Weekly Salary,
or Other Weekly Earnings
Starting Final
Resigned Terminated Supervisor’s Name
OR
State Reason:
E Employer Dates Employed Summary of Work Performed
& Job Responsibilities
From (Mo/Yr) To (Mo/Yr)
A Address (City, State, Zip)
Phone:
J Job Title Hourly Rate, Weekly Salary,
or Other Weekly Earnings
Starting Final
Resigned Terminated Supervisor’s Name
OR
State Reason:
E Employer Dates Employed Summary of Work Performed
& Job Responsibilities
From (Mo/Yr) To (Mo/Yr)
A Address (City, State, Zip)
Phone:
J Job Title Hourly Rate, Weekly Salary,
or Other Weekly Earnings
Starting Final
Resigned Terminated Supervisor’s Name
OR
State Reason:
©Quality Pro Page 2 of 5 April 2006
TELL US ABOUT YOURSELF
You must answer every question on this application. If a question does not apply, put “N/A.” Please print.
What position are you applying for?
What is your salary expectation? $ W hen can you start work? (Date)
How were you referred to us?
(If you were referred by a person, please provide the name)
Yes No
Have you completed an application here before? If yes, date/location
Yes No
Have you been employed here before? If yes, date/position/location
Full-time Part-time Temporary Nights W eekends
Are you available to work (Check any that apply):
Yes No
Are there any days or times during the week that you are not available to work?
(Reasonable accommodation of religious needs that do not create an undue hardship will be considered, if applicable)
If yes, please list the days/times you are not available to work
Yes No
If necessary, can you provide proof that you are over any minimum work age requirement?
Yes No Yes No
Are you willing to work overtime? Do you have steady transportation to work?
Yes No
Can you travel, if required? What percentage of time?
Yes No Yes No
Are you on a layoff and subject to recall? May we contact your present employer?
How much time have you lost from work during the past 12 months?
Yes No
Are you now, or do you expect to be, engaged in any other business or employment while working here?
If yes, please explain
Yes No
Are you presently an officer, employee, or employer of another business in our industry or with whom we compete?
If yes, please explain
Yes No
Have you ever been terminated or asked to resign from a job?
If yes, please explain
Yes No
Have you ever been refused bond?
Why do you desire to make a change?
Yes No
Are you legally eligible to work in the United States? (Proof of citizenship status/identity required upon hire)
What three things are most important to you in a job? 1) 2) 3)
What three adjectives best describe you? 1) 2) 3)
What type of work do you most enjoy?
Why do you want to work here?
TELL US ABOUT YOUR SPECIAL SKILLS AND QUALIFICATIONS
List any special skills, training, experience, certifications, or licenses that may be relevant to this position or our company
List any professional, trade, business, or civic activities or offices held that would relate to working here
List any foreign languages that you fluently sp eak, read, and/or write that would relate to working here
List software programs that you are proficient in
©Quality Pro Page 3 of 5 April 2006
YOUR EDUCATIONAL BACKGROUND
Did You Years Degree Received and
Schooling Name of School Location
Graduate? Completed Major Subject
High School
Yes No
or GED
Trade, Business, or
Yes No
Correspondence
Yes No
College
Yes No
Graduate School
TELL US ABOUT YOUR DRIVING RECORD
Necessary for positions that may require use of a personal or comp any vehicle for work
Yes No
Do you hold a valid Driver’s License? If yes, provide the state
Yes No
Have you been convicted of any moving violation(s) in the last 3 years?
If yes, give date(s) and explanation of each
TELL US ABOUT YOUR PAST
Answering “yes” to any of these questions is not an automatic bar to employment.
Have you ever been disciplined or terminated from any job for an act of violence, harassment, discrimination, ethical breach or theft?
Yes No If yes, explain the circumstances, employer, and date
Have you ever been a defendant in a civil action for an intentional tort ? (e.g. assault, battery, false imprisonment, infliction of emotional distress,
tortuous interference with a business relationship, defamation, invasion of privacy, fraud and misrepresentation, abuse of process and malicious prosecution or others)
Yes No If yes, provide an explanation of the nature of the intentional tort, the date of the action, the location, and the
disposition or outcome
Do you currently have any criminal charges pending against you?
Yes No If yes, describe the details of the charge(s), the date(s) of the offense(s) (month and year), your age at the time
of the offense(s), and the current status of the charge(s)
Are you currently wanted by any law enforcement agency?
Yes No If yes, by what agency and for what act?
©Quality Pro Page 4 of 5 April 2006
TELL US ABOUT ANY RECORDS
Must be answered by all candidates other than those in Massachusetts.
Have you ever been convicted of; received a sentence for; pled nolo contendere (no co ntest) to; been placed on probation, fined, or
entered a pretrial intervention program for; or had adjudication withheld by any judicial or quasi -judicial body for a crime, other than a
minor traffic violation? (Any criminal record not disclosed by you may be considered falsification of this application, which may result in revocation of your
employment offer or termination of your employment. Also, in accordance with any state or federal regulations, you may be re quired to provide copies of any criminal
records. Answering “yes” to this question is not an automatic bar to employment.)
Yes No If yes*, describe the details of the conviction or other disposition of the charge, the date of the offense (month
and year), your age at the time of the offense, and your rehabilitation since the conviction and/or disposition of
the offense (See below for specific instructions related to your particular state. If your state is not listed, answer this question as worded.)
Applicants do not have to disclose erased records of arrests, criminal charges, or convictions;
*Connecticut Candidates:
Applicants with erased criminal records can swear under oath that they have never been arrested; and
Criminal records eligible for erasure include delinquency determinations, findings as a child in a family with service needs, youthful offender
adjudications, dismissed or nolled criminal charges, criminal charges where the accused was found not guilty or received an a bsolute pardon,
and any other conviction where erasure is allowed by law.
*Michigan Candidates: For any misdemeanors, list only those that resulted in convictions.
*Nevada Candidates: List all felony convictions and any misdemeanor convictions that occurred in the past 10 years and that resulted in imprisonment.
*Rhode Island Candidates: List convictions only.
*Utah Candidates: For any convictions, list only felonies.
*Washington State Candidates: List any convictions or terms of imprisonment within the past 10 years only.
YOUR MILITARY SERVICE
Branch of Service Rank at Discharge, If Applicable
List Duties and Special Training and/or Skills
AGREEMENT AND RELEASE
For the purpose of this agreement and release, the organization that has provided you with this application is refer red to as “the company,” “this
company,” or “you”. The facts set forth above in my application for employment are true and complete. I understand that fal se statements or omission
of information on this application (even if discovered after employment) o r any other employment form may lead to dismissal or denial of employment.
You are hereby authorized to make any investigation of my personal history, financial, criminal, credit, and motor vehicle re cords through any
investigative or credit agencies or bureaus of your choice. You are also authorized to administer a personality profile or other pre -employment tests
and verify my background. A criminal record or sentence is not an automatic disqualification for employment. I agree to sub mit to any drug or alcohol
testing prior to or after employment, and I agree to submit to a medical evaluation, if required. I consent to the release o f any or all medical information
or records deemed necessary to determine my capability to perform the essential job func tions of the position for which I may hold.
In making this application for employment, I also understand that an investigative consumer report may be made whereby inform ation is obtained
through personal interviews with my neighbors, friends, or others wi th whom I am acquainted. In exchange for the consideration of my employment
application by this company, I hereby release and forever discharge this company (including its directors, officers, employees, and agents) and my past
and/or present employers (including their directors, officers, employees, and agents) from any liabilities which may result from an investigation of my
past and/or present employment or from the disclosure of such information. I authorize the use of any information in this ap plication to verify my
statements, and I authorize past employers, doctors, all references, and any other persons to answer all questions asked conc erning my ability,
character, reputation, and previous employment record.
I understand that if my application is accepted that employment with this company at all times is employment “at will." It is further understood that this
“at will” relationship may not be changed by any written document, verbal statements, or by conduct unless an authorized exec utive of this company
specifically acknowledges such change. I further understand that my “at will” employment may be terminated at any time by th is company or myself
and includes no guarantee, contract, or promise of employment for any specific length of time. I unde rstand that the first 90 days of employment is a
new-hire introductory period.
I have read, understand, and by my signature consent to these statements.
Signature of Applicant Date
YOUR EMERGENCY CONTACT
In Case of an Emergency, I Authorize You to Contact:
Name Telephone Number
©Quality Pro Page 5 of 5 April 2006
Contact this candidate