GILROY, KERNAN & GILROY APPLICATION FOR EMPLOYMENT

To be considered for employment, this Application for Employment Form must be completed and electronically signed personally by the applicant. Each question must be answered in full, even if a resume is provided. If an answer is NO or NOT APPLICABLE, indicate such. We are an Equal Opportunity Employer. We consider all applications for all positions without regard to race, color, religion, gender, national origin, age, sexual orientation, genetic predisposition or carrier status, disability, marital status, pregnancy, veteran status, or any other legally protected class or status. Please notify a company representative if you require a reasonable accommodation to participate in the application and/or interviewing process.

Name (First, Middle, Last)*
Address:*
Phone Number:*
-
E-mail Address:*
Position Applied For:*
Are You Available to Work
(Check All that Apply)
*
Salary or Hourly Wage Desired:*
Date Available to Start:*
Are You 18 years or older*
Are You Currently Employed:*
If Yes Can we contact your current employer?
Have you ever submitted an application and/or interviewed for employment with our company? :*
Is Yes When:
 / 
 / 
Are you legally eligible for employment in the United States? Employment eligibility will be verified upon employment. *
If you have received a copy of the job description for the position for which you are applying, can you perform the essential functions of this job with or without reasonable accommodation? (Choose either: Yes, No, or N/A (I have not been provided a copy of the job description)*

Educational Background

High School

Name and Location:*
# of Years Completed:
Course of Study/Major:
Diploma or Degree Obtained:
GPA:

College

Name and Location:
# of Years Completed:
Course of Study/Major:
Diploma or Degree Obtained:
GPA:

Other

Name and Location:
Course of Study/Major:
Diploma or Degree Obtained:
GPA:

Skills

List any certificates, licenses, or professional achievements that would support your qualifications for employment: *
List any additional skills, training, and/or technical/professional knowledge that is relevant to the job for which you are applying: *

EMPLOYMENT HISTORY

Provide employment information, including military service, for the last 15 years, starting with the most recent employer first.

Name of Employer:
Employer Address:
Employer Phone:
-
Employment Dates (Start/End)
Starting Hourly Wage/Salary:
Job Title of Position(s):
Final Hourly Wage/Salary:
Name and Job Title of Supervisor:
Brief description of job duties, responsibilities and significant accomplishments
Reason For Leaving:
Name of Employer:
Employer Address:
Employer Phone:
-
Employment Dates (Start/End):
Starting Hourly Wage/Salary:
Job Title of Position(s):
Final Hourly Wage/Salary:
Name and Job Title of Supervisor:
Brief description of job duties, responsibilities and significant accomplishments
Reason For Leaving:
Name of Employer:
Employer Address:
Employer Phone:
-
Employment Dates (Start/End):
Starting Hourly Wage/Salary:
Job Title of Position(s):
Final Hourly Wage/Salary:
Name and Job Title of Supervisor:
Brief description of job duties, responsibilities and significant accomplishments
Reason For Leaving:

REFERENCES

List three references other than relatives or former supervisors

Reference Name:
Occupation/Title:
Reference Phone:
-
Relationship to Applicant:
Years Known:
Reference #2 Name:
Occupation/Title:
Reference #2 Phone:
-
Relationship to Applicant:
Years Known:
Reference #3 Name:
Occupation/Title:
Reference #3 Phone:
-
Relationship to Applicant:
Years Known:

Upload Your Resume

Upload Resume:

CONVICTION RECORD STATUS

All applicants and employees must, as a condition of employment, inform the company of all convictions. This includes all convictions received within the past seven years, while your application for employment is pending, and within seven days of receiving a conviction if currently employed.

Have you ever been convicted of, and/or plead guilty to, a felony or misdemeanor in the past seven years?

If you answered ‘yes’ and have been convicted of a felony or misdemeanor, please provide additional in formation such as the crime(s), date(s), court location, sentencing information, disposition of sentence, and rehabilitation completed. Please note that a ‘yes’ answer to this question does not necessarily disqualify an applicant from employment. Factors that will be taken into account include the nature of the conviction as it relates to the job applied for, the amount of time that has elapsed since the conviction and/or completion of sentence, and the seriousness of the offense. The company reserves the right to reject individuals for employment based on job-related convictions.

Date of Offense:
Conviction/Explanation:
County and State in which Offense Occurred:
Rehabilitation Completed:
Date of Offense:
Conviction/Explanation:
County and State in which Offense Occurred:
Rehabilitation Completed:
Date of Offense:
Conviction/Explanation:
County and State in which Offense Occurred:
Rehabilitation Completed:

PLEASE READ CAREFULLY AND SIGN BELOW

I hereby certify that all of the information I have provided on this Application for Employment Form is accurate and complete to the best of my knowledge. I understand that any misrepresentation or omission of facts will disqualify me from further consideration of employment, withdrawal of any offer of employment, or termination of employment, if hired.

I authorize verification of all of the information I have provided on this Application for Employment Form as well as any additional information needed to consider my application for employment. I authorize all previous employers, educational institutions, references, and other persons who have knowledge of me or my records to provide any and all information pertinent to myemployment and release the same from any liability resulting from providing such information. I also release this organization and all of its employees from all liability for any damage that may result from reliance on the information furnished.

The company is committed to providing a drug and alcohol-free workplace. After receiving a conditional offer of employment, I understand that a drug test will be required before starting work. If the results of the test are positive, I understand that the offer of employment will be withdrawn.

If employed, I agree to abide by all policies, procedures, rules, and regulations of the organization. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages or salary, be terminated by myself or the company at any time with or without cause or notice. I further understand that the policies, procedures, rules, and benefits contained in the employee handbook, benefit plans, and other written documents should not be considered an employment contract for any period of time.

Date Signed:
Electronic Signature: