EMPLOYMENT APPLICATION Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, physical or mental disability, or veteran status. JOB SPECIFICATIONS Position Applying For: __________________________ Salary Desired: _______________ ______________ Driver License No. ______________ Class ____ Ever applied to this position before? { } Yes { } No State of Issuance: ___ If yes, when? ___________________________ Date Available for Work: Full-Time Availability? { } Yes { } No Part-Time-Time Availability? { } Yes { } No PERSONAL INFORMATION ______________________ __________________ _____________ Last Name First Name Middle ______________________ __________________ _____ _______ Address City State Zip _________________ _________________ ____________________ Home Phone Cell Phone Email _________________ Social Security No. Are you a U.S. Citizen? { } Yes { } No Have you ever been convicted of a felony?* { } Yes { } No If offered an apprenticeship are you willing to submit a pre-employment drug screening test? { } Yes { } No *A yes to the above question does not necessarily disqualify an applicant from employment. EDUCATION School Name Location Years Attended Degree Earned Major EMPLOYMENT HISTORY ______________________ __________________ _____________ Employer Final Position Dates Employed ______________________ __________________ _____________ Work Phone Supervisors Name & Title Final Rate of Pay ______________________ __________________ _____ ________ Address City State Zip ___________________________________________________ __________________________________________________________ Reason for Leaving: ____________________________________________ Duties: May we contact this employer? { } Yes { } No EMPLOYMENT APPLICATION EMPLOYMENT HISTORY ______________________ __________________ _____________ Employer Final Position Dates Employed ______________________ __________________ _____________ Work Phone Supervisors Name & Title Final Rate of Pay ______________________ __________________ _____ ________ Address City State Zip ___________________________________________________ __________________________________________________________ Reason for Leaving: ____________________________________________ Duties: May we contact this employer? { } Yes { } No EMPLOYMENT HISTORY ______________________ __________________ _____________ Employer Final Position Dates Employed ______________________ __________________ _____________ Work Phone Supervisors Name & Title Final Rate of Pay ______________________ __________________ _____ ________ Address City State Zip ___________________________________________________ __________________________________________________________ Reason for Leaving: ____________________________________________ Duties: May we contact this employer? { } Yes { } No REFERENCES Name (Please limit your references to 1-Personal) Title Company Phone EMERGENCY CONTACT Name Relationship Home Phone Cell Phone NOTE: Applications not filled out in its entirety will be considered for employment. EMPLOYMENT APPLICATION PLEASE READ BEFORE SIGNING: I, _______________________________, certify that all information and documentation that I provided is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application. I, _______________________________, authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that Willie A. Watkins Funeral Home and my previous employers will not be liable in any respect if a job offer is not extended, or it is withdrawn, or my employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees. In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. I have received from the company a list of approved documents that are required. I, _______________________________, understand that employment at this company is “at will”, which means that either I or this company can terminate the employment relationship at any time, with or without prior notice and for any reason not prohibited by statue. All employment is continued on that basis. I hereby acknowledge that I have read and understand the above statements. Signature: __________________________________________________ Date: _____________________