People's Resource Center
Application for Employment
PRC logo
We consider all applicants for all positions without regard to race, color, religion, sex, national origin, age, veteran status, the presence of a non-job-related medical condition or disability or any other legally protected status.
Position you are applying for:   Date of Application:  

Last Name:
 		First Name:
 		Middle Name:

Address:  

City:   Zip:  

Home Telephone #:   Cell Telephone #:  

Education
 
Name and Location of School
No. of Years Attended
Did you Graduate?
Subjects Studied
High School
Yes 
No 
College
Yes 
No 
Trade, Business
or
Other School
Yes 
No 

Languages
Please indicate all languages that you can speak, read and/or write.
Name of Language Speak, Read, or Write Fluent, Good or Fair

Employment History
Please provide a complete employment history listing all positions held, including military, part-time, summer and volunteer, submitting additional forms if necessary. List in chronological order starting with the most recent or present position.

m
o
s
t

r
e
c
e
n
t
From
Month:
 		Year
To
Month:
 		Year
Name and Address of Employer:
 Salary or Hourly Rate:
 Position Title:
 Reason for Leaving:
Principal Duties:
Name and Title of Supervisor:

2

From
Month:
 		Year
To
Month:
 		Year
Name and Address of Employer:
 Salary or Hourly Rate:
 Position Title:
 Reason for Leaving:
Principal Duties:
Name and Title of Supervisor:

3

From
Month:
 		Year
To
Month:
 		Year
Name and Address of Employer:
 Salary or Hourly Rate:
 Position Title:
 Reason for Leaving:
Principal Duties:
Name and Title of Supervisor:


1.   Are you currently employed?    Yes     No
2.   May we contact your present employer?    Yes     No
3.   Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
(Proof of citizenship or immigration status will be required upon employment) 		   Yes     No
4.   Have you ever had any job-related training in the US Military?    Yes     No
  If yes, please describe:
5.   Have you been convicted of a crime?    Yes     No
6.   On what date would you be available to work?  
7.   Are you available to work? (check all that apply)
Full-time         Part-time         Temporary         Saturday         Evenings

References
Give the names of three persons not related to you, whom you have known at least one year.
Name Address How do you know them? Telephone # Years known


In case of an emergency, please notify:

Name:   Telephone #:   Relationship:  


Overall Comments:


I declare that the information provided by me is complete and true to the best of my knowledge. I am aware that any misrepresentation or omission may preclude an employment offer, or may result in withdrawal of an employment offer or separation of employment. I authorize investigation of all information provided by me in the application process. I understand that any offer of employment is contingent on the completion of a satisfactory background investigation and verification of employment. I also understand that employment with People's Resource Center is at will and the employment relationship may be ended by either party, at any time, with or without notice.

I have read the above and agree to everything stated in the above paragraph. Date of Agrement:  


Last updated: 4/24/08