want to work with us?

employee application

First Name
Middle
Last Name
Maiden Name
Present Address
City
State
Zip Code
How long have you lived at the address above?
Phone Number
Email Address
Emergency Contact Name
Emergency Contact Phone
Personal Information
1 / 15
Position Applied For
Desired Salary
Days Available to Work:
How many hours can you work weekly?
Can you work nights?
Employment Desired
When are you available to start work?
Position Information
2 / 15
Name of High School
Number of years completed
Location Complete Mailing Address
High School Education
3 / 15
Name of College
Number of years completed
Major and Degree
Location Complete Mailing Address
College Education
4 / 15
Name of School
Number of years completed
Major and Degree
Location Complete Mailing Address
Bus. or Trade School Education
5 / 15
Name of School
Number of years completed
Major and Degree
Location Complete Mailing Address
Professional School Education
6 / 15
Have you ever been convicted of a crime
If yes, explain number of conviction(s), nature of offense(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation:
Other Information
7 / 15
Do you have a driver's license?
What is your means of transportation to work?
Driver's License Number
State of Issue
Expiriation Date
Special
Have you had any accidents during the past three years?
If yes how many?
Have you had any moving violations during the past three years?
If yes how many?
Transportation Information
8 / 15
Have you ever been in the armed forces?
Are you now a member of the national guard
Specialty
Date Enlisted
Discharge Date
Military Information
10 / 15
Reference 1
Name
Position
Company
Address
Position
Phone Number
Reference 2
Name
Position
Company
Address
Position
Phone Number
References
9 / 15
Employer 1

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. If you need additional space, please e-mail employment@miserenity.com with additional information.

Name of Employer
Address
City, State, ZIP
Employer Phone Number
Name of Last Supervisor
Employment Start Date
Employment End Date
Starting Pay or Salary
Final Pay or Salary
Your Last Job Title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company
Work Experience
11 / 15
Employer 2

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. If you need additional space, please e-mail employment@miserenity.com with additional information.

Name of Employer
Address
City, State, ZIP
Employee Phone Number
Name of Last Supervisor
Employment Start Date
Employment End Date
Starting Pay or Salary
Final Pay or Salary
Your Last Job Title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company
Work Experience
12 / 15
Employer 3

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. If you need additional space, please e-mail employment@miserenity.com with additional information.

Name of Employer
Address
City, State, ZIP
Employer Phone Number
Name of Last Supervisor
Employment Start Date
Employment End Date
Starting Pay or Salary
Final Pay or Salary
Your Last Job Title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company
Work Experience
13 / 15
Employer 4

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. If you need additional space, please e-mail employment@miserenity.com with additional information.

Name of Employer
Address
City, State, ZIP
Employer Phone Number
Name of Last Supervisor
Employment Start Date
Employment End Date
Starting Pay or Salary
Final Pay or Salary
Your Last Job Title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company
Work Experience
14 / 15
Did you complete this application yourself?
If no, who completed the application?

By clicking Submit, you authorize the information provided in this Application for Employment is true, correct and complete. If employed, any misstatements or omissions of fact on this application may result in my dismissal.

I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.

If you decide to engage an investigative consumer reporting agency to report on my credit and personal history, I authorize you to do so. If a report is obtained you must provide, at my request, the name and address of the agency so I may obtain from them the nature and substance of the information contained in the report.

Confirmation
15 / 15
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