DATE:

Name:

Present Address:

Are you under 18 years of age?

YESNO

If hired, can you submit employment verification of your legal right to work in the United States?

YESNO

POSITION APPLIED FOR & MINIMUM SALARY DESIRED

Days/hours available to work

NO PREF
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY

Employment desired:

FULL-TIME ONLYPART-TIME ONLYTEMPORARY/AS-NEEDED

Date available to work?

Have you ever been involuntarily dismissed from a position? If yes, please explain:

TYPE OF SCHOOL NAME OF SCHOOL LOCATION NUMBER OF YEARS COMPLETED MAJOR & DEGREE

High School

College

Bus. or Trade School

Professional School

IF DRIVING A PERSONAL OR COMPANY VEHICLE IS REQUIRED FOR YOUR POSITION:
Do you have a Driver’s License?

YESNO

Type:

OPERATORCOMMERCIAL (CDL)CHAUFFEUR

List all traffic violations you have had in the past three years

If hired, are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodation?

YESNO

If hired, are you able to work nights and/or weekends (as the nature of this job requires a flexible schedule)?

YESNO

Please list any job-related organizations or professional societies you belong to:

Please exclude those which indicate race, creed, color, age, religion, national origin or ancestry, disability, marital status, veteran status, sexual orientation, gender identification or expression, medical condition, genetic characteristics or information, or any other characteristic protected by state or federal laws.

OFFICE SKILLS

Indicate computer software and social networking programs with which you have proficiency:

Typing

YESNO

WPM

10-key

YESNO

Word Processing

YESNO

WPM

Personal Computer

YESNO

Type

PCMAC

Other Skills

Please list two references other than relatives or previous employers:

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

MILITARY

HAVE YOU EVER BEEN IN THE ARMED FORCES?

YESNO

ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?

YESNO

Specialty/Relevant Skills Acquired

Work experience:

Please list all your work experience for the past ten years beginning with your most recent job held. If you were self-employed, give company name. Do not omit any positions held. Attach additional sheets if necessary.

EMPLOYMENT DATES:

May we contact this employer?

YESNO

Reason for leaving (be specific):

List the job(s) you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

EMPLOYMENT DATES:

May we contact this employer?

YESNO

Reason for leaving (be specific):

List the job(s) you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

EMPLOYMENT DATES:

May we contact this employer?

YESNO

Reason for leaving (be specific):

List the job(s) you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

EMPLOYMENT DATES:

May we contact this employer?

YESNO

Reason for leaving (be specific):

List the job(s) you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

May we contact your present employer?

Did you complete this application yourself

YesNo

Please account for any periods of unemployment:

PLEASE READ CAREFULLY AND SIGN BELOW

In exchange for the consideration of my job application by ABA WORKS (hereinafter called “the Company”), I agree that:
I certify that the information in this application is true and correct to the best of my knowledge. I further certify that I, the applicant, have personally completed this application. I understand that any misrepresentation, falsification, or omission of information on this application or on any document used to secure employment shall be grounds for rejection of this application or immediate discharge if I am employed, regardless of the time elapsed before discovery.

The Company adheres to a policy of at-will employment, which recognizes that each employee and the Company each retains the right to terminate the employment relationship at any time, with or without cause or notice. Length of service is not a factor in decisions concerning salary, job classification, or eligibility for promotion, nor does it create or imply any agreement or contract for continued employment. No one other than the Chief Executive Officer has the authority to make any binding promiseor enter into any agreement inconsistent with the Company’s at-will policy, and such an agreement must be signed by both parties and be in writing to be effective. Both the undersigned and /or the Company may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize the Company to thoroughly investigate the information on my application, my references, work record, education, or other matters related to my suitability foremployment; and, further, I authorize my former employers, educational institutions, and references to disclose to the Company any information related to me. I release the Company, my former employers, educational institutions, and all other persons from any and all claims, demands, or liabilities arising out of or in any way related tosuch investigation or disclosures.

I understand that employment depends on verification of information submitted in connection with my application for employment; passing a pre-employmentphysical examination if required, conducting a background check, if required, or other satisfying legal requirements for access to controlled information within a reasonable periodof time if required, and signing the Acknowledgment of Handbook attesting that you have read and understand the Company’s policies and procedures.

I further understand that my employment with the Company shall be introductory for a period of ninety (90) days, and further that at any time during the introductory period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

DATE: