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Application for Employment

An Equal Opportunity Employer

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Email *

Position Applied For *

Expected Salary *

Date Available *

YYYY

Will accept seasonal work?

Yes

Seeking summer work?

Yes

Do you have a driver's license?

Yes

Are you legally authorized to work in the U.S.? *

Yes

If you are applying for a sales position, list your top three geographic preferences

Are you willing to relocate?

Yes

Are you willing to travel?

Yes

Education

Name of High School *

I have a G. E. D.

Yes

Highest Grade Completed

G.P.A.

Name of College

Major area of study

Did you Graduate?

Yes

Degree Obtained

G. P. A.

Continued Education

Name and kind of other schools, seminar or training.

List any professional certifications or licenses.

List extra-curricular activities and hobbies.

List all employment for the last seven years. (list present or most recent first, and explain all breaks).

Employer #1 *

Position/Title *

Supervisor's Name

First Name

Last Name

Start Date *

YYYY

End Date

YYYY

I currently work here *

Employer's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Select One *

Permanent

Temporary

Select One *

Full-time

Part-time

Describe your duties and responsibilities *

Reason for leaving

Employer #2

Position/Title

Supervisor's Name

Start Date

YYYY

End Date

YYYY

Employer's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Select One

Permanent

Temporary

Select One

Full-time

Part-time

Describe your duties and responsibilities *

Reason for leaving

Employer #3

Position/Title

Supervisor's Name

First Name

Last Name

Start Date

YYYY

End Date

YYYY

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Select One

Permanent

Temporary

Select One

Full-time

Describe your duties and responsibilities. *

Employer #4

Employer's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Select One

Permanent

Temporary

Select One

Full-time

Part-time

Describe your duties and responsibilities. *

Supplementary Information

How did you hear about Brown & Haley?

Friends/Relatives

Indeed

Instagram

Website

Other

Have you ever applied to work for us in the past?

Yes

If yes, what was the date of application?

YYYY

Position applied for

Previously employed by Brown & Haley

Yes

If yes, what position did you hold?

Start Date

YYYY

End Date

YYYY

Reason for Leaving

Do you have any relatives who work for Brown & Haley? *

Yes

If yes, what is their name and position held? *

List three personal references

Personal Reference #1 *

First Name

Last Name

Occupation *

Relationship *

Friend

Neighbor

Relative

Other

Personal Reference #2

First Name

Last Name

Occupation

Relationship

Friend

Neighbor

Relative

Other

Personal Reference #3

First Name

Last Name

Occupation

Relationship

Friend

Neighbor

Relative

Other

I herby certify that the information given in this application is correct and true to the best of my knowledge. I authorize Brown & Haley to contact any of my schools or former employers, except those indicated, and authorize these entities to furnish all information requested in connection with this employment application. I understand that if employed, any misrepresentation of the information furnished by me shall be sufficient case for dismissal. Additionally, I further understand that should I be employed by Brown & Haley, any and all claims I should have arising out of or relating to my employment, after all union preceedings (if applicable) have been exhausted, will be subjected to mandatory arbitration.

I agree

I do not wish to be considered for employment with Brown & Haley..

Thank you!

Various federal and state laws prohibit discrimination of race, creed, color, sex, marital status, age, national origin or the presence of a non job related handicap. Evaluation of your employment with this company will be based only upon your qualifications and merit. Brown & Haley is an affirmative action, equal opportunity employer.

Please fill out the application form below to be considered for employment.